RCEM Research Grant Application Form

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RCEM Research Grant Application Form
Lead Applicant

Please provide all the details for the Lead applicant
Name

TitleFirst NameLast Name
RCEM Membership category
Email
example@example.com
Position
Institution/Authority
16 Digit ORCID ID
Role on Grant
Describe role
Hours per week on project
Date of CCT

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate

Qualifications

Current Post
Current post start date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Five most relevant publications
How many additional applicants are there
If you need any assistance completing this form or have any questions about the application process, please contact Research@rcem.ac.uk
Additional Applicant 1
Name

TitleFirst NameLast Name
Position
Institution/Authority
16 Digit ORCID ID
Role on Grant
Hours per week on project
Date of CCT

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate

Current Post
Current post start date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Recent Publications
Additional Applicant 2
Name

TitleFirst NameLast Name
Position
Institution/Authority
16 Digit ORCID ID
Role on Grant
Hours per week on project
Date of CCT

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate

Current Post
Current post start date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Recent Publications
Additional Applicant 3
Name

TitleFirst NameLast Name
Position
Institution/Authority
16 Digit ORCID ID
Role on Grant
Hours per week on project
Date of CCT

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate

Current Post
Current post start date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Recent Publications
Additional Applicant 4
Name

TitleFirst NameLast Name
Position
Institution/Authority
16 Digit ORCID ID
Role on Grant
Hours per week on project
Date of CCT

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate

Current Post
Current post start date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Recent Publications
Additional Applicant 5
Name

TitleFirst NameLast Name
Position
Institution/Authority
16 Digit ORCID ID
Role on Grant
Hours per week on project
Date of CCT

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate

Current Post
Current post start date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Recent Publications
Additional Applicant 6
Name

TitleFirst NameLast Name
Position
Institution/Authority
16 Digit ORCID ID
Role on Grant
Hours per week on project
Date of CCT

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate

Current Post
Current post start date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Recent Publications
Additional Applicant 7
Name

TitleFirst NameLast Name
Position
Institution/Authority
16 Digit ORCID ID
Role on Grant
Hours per week on project
Date of CCT

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate

Current Post
Current post start date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Recent Publications

Institution/Authority administering grant
Institution/Authority administering grant address

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Project Title
Abstract of research

0/250
Proposed starting date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Proposed duration (in months)

Summary of support requested - Detail summary of costs by year

Total cost of Summary of Support Requested
Does the Project have Ethical Committee approval?
If Project does not require Ethical Committee approval - state why
If you need any assistance completing this form or have any questions about the application process, please contact Research@rcem.ac.uk

Head of Department
Head of department signature upload

Cancelof
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Name

TitleFirst NameLast Name
Department
If you need any assistance completing this form or have any questions about the application process, please contact Research@rcem.ac.uk

Finance Officer of Grantholder
Finance Officer signature upload

Cancelof
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Name

TitleFirst NameLast Name
Position held
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
If you need any assistance completing this form or have any questions about the application process, please contact Research@rcem.ac.uk

Primary Methodology
The primary methodology in your project is:
If you need any assistance completing this form or have any questions about the application process, please contact ResearchAdmin@rcem.ac.uk

Proposed Investigation

Quantitative
Project Title
Lay summary

0/200
Research in PICO (population, intervention/exposure, comparator, outcome) format

0/150
Background to the study

0/200
Results of any previous work or pilot work undertaken in preparation for this application

0/150
Patient and Public Involvement

0/150
Study Design

0/50
Setting

0/50
Eligibility (inclusion and exclusion criteria)

0/150
Proposed interventions

0/150
Duration of treatment

0/150
Outcome measures: Primary Endpoint (include time at which measured)

0/150
Outcome measures: Secondary Endpoints

0/150
Follow up

0/150
Proposed sample size

0/150
Power Calculation

0/150
Proposed statistical analysis
Predicted barriers to completion and planned mitigation

0/200
Upload Gantt Chart

Cancelof
Justification for support requested

0/100
Other funding secured / applied for

0/50
Is this a resubmission?
If Yes - If so please briefly describe changes from the original application

0/100
Value of research to Emergency Medicine

0/100
Potential academic development of lead applicant

0/100
Potential opportunities for future funding

0/100
How will results be disseminated?

0/50
Key References
Please include your RCEM Grant Details of Support Requested

Cancelof
If you need any assistance completing this form or have any questions about the application process, please contact Research@rcem.ac.uk

Proposed Investigation

Qualitative
Project Title
Lay summary

0/150
Research in PICo (Population, Phenomena of Interest, Context) format

0/150
Background to the study

0/200
Results of relevant previous or pilot work

0/150
Patient and Public Involvement

0/150
Expertise available and existing facilities

0/100
Study Design

0/50
Setting

0/50
Eligibility (inclusion and exclusion criteria)

0/150
Phenomena of interest

0/150
Trustworthiness and rigour

0/150
Approach to data analysis

0/150
Sample size

0/150
Power calculation
Proposed statistical analysis
Predicted barriers to completion and planned mitigation

0/200
Expertise available and existing facilities

0/100
Upload Gantt Chart

Cancelof
Justification for support requested

0/100
Other funding secured / applied for

0/50
Is this a resubmission?
If Yes - If so please briefly describe changes from the original application

0/100
Value of research to Emergency Medicine

0/100
Potential academic development of lead applicant

0/100
Potential opportunities for future funding

0/100
How will results be disseminated?

0/50
Key References
Please include your RCEM Grant Details of Support Requested

Cancelof
If you need any assistance completing this form or have any questions about the application process, please contact Research@rcem.ac.uk

Form Complete

Your RCEM Research Grant Application Form will be sent for review once you press Submit
If you need any assistance completing this form or have any questions about the application process, please contact ResearchAdmin@rcem.ac.uk
Should be Empty:

Lead Applicant