ESCRS Systematic Review Award (SRA) 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 two A4 pages, word limits are provided
Title of Project
*
Abbreviated title
*
Total funding requested (in €)
*
Please include at least 4 keyterms that are relevant to your project
*
Project durations (in months)
*
Projected start date
*
Project Summary (250 words max)
*
0/250
Aims / Objective (200 words max)
*
0/200
Relevance (400 words max)
*
0/400
Methodology (400 words max)
*
0/400
Expected outcomes (200 words max)
*
0/100
Detailed budget breakdown (e.g. consumables, personnel time, clinical time release, equipment, travel) (200 words max)
*
0/200
Timeline (key milestones)
*
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.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Other sources of funding (if any)
Declaration of Interests (include any declaration of interests relevant to your project and to the policy outlined on the SRA page)
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 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
I confirm that I do not have any conflict of interest with any ESCRS Research Committee members, as well as the Executive, Trustees, Council Members and co-opted Council Members
Signature
Please verify that you are human
*
Save
Submit
Should be Empty: