ESCRS Pioneer Research (PRA) Award Application Form
1. Principal Investigator (PI) Details
Name
*
First Name
Last Name
Email
*
example@example.com
Repeat Email
*
example@example.com
Phone Number
*
-
Country code
Phone Number
Institution/Hospital
*
Current position
*
Academic Qualifications (100 words max)
*
0/100
Years in practice / research
*
Are you an ESCRS member?
*
Yes
ESCRS membership number
*
2. Co-investigator details
Co-investigator 1 name
First Name
Last Name
Co-investigator 1 email
example@example.com
Co-investigator 1 Institution/Hospital
Co-investigator 1 Current position
Co-investigator 2 name
First Name
Last Name
Co-investigator 2 email
example@example.com
Co-investigator 2 Institution/Hospital
Co-investigator 2 Current position
Details of any other investigators/collaborators
3. Project Information
This entire section should amount to no more than four A4 pages, word limits are provided
Title of Research Project
*
Abbreviated title
*
Project durations (in months)
*
Projected start date
*
Project Summary (250 words max)
*
0/250
Research Question / Objective (200 words max)
*
0/200
Background and significance (400 words max)
*
0/400
Methodology (400 words max)
*
0/400
Timeline (key milestones)
*
Expected outcomes (200 words max)
*
0/100
Feasibility justification (200 words max)
*
0/200
Dissemination plan (e.g. journal submission, conference presentations, podcasts, etc.) (200 words max)
*
0/200
If you wish to upload a Gantt chart and/or your budget as a spreadsheet then please do so here. This is not mandatory and no other files will be reviewed.
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4. Budget
Total funding requested (in €)
*
Detailed budget breakdown (e.g. consumables, personnel time, clinical time release, equipment, travel)
*
Other sources of funding (if any)
5. Declarations
By submitting this form you confirm that:
*
The information provided is accurate and complete
You are authorised to submit the application on behalf of the proposed project team
The lead investigator is a legal entity capable of entering into a contract with ESCRS
You agree to ESCRS's data and ethical guidelines for research
You agree with the ESCRS Grant Agreement Terms (link provided on grant information page)
You hold a full-time or affiliated post with an established clinical or research institute named above, who have agreed to act as Sponsors for the research proposed and have the expertise required to support the administrative, insurance and regulatory requirements necessary for the conduct of this study;
You consent for ESCRS and its administrative partners to store and process your data contained within the application
You understand that any ownership of any intellectual property arising from the project will be subject to agreement between the sponsoring institution and ESCRS prior to the commencement of funding, in accordance with the ESCRS Intellectual Property policy
Signature
Please verify that you are human
*
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