MELBOURNE NEUROSCIENCE INSTITUTE GUELMA ALEXANDER CLINICAL FELLOWSHIP IN NEUROSCIENCE 2019

APPLICATION FORM – 2019 COMMENCEMENT

Closing Date: Friday 17th August 2018

Proposal/Project Title

Applicant Details.

Name      

Date of PhD graduation

University of Melbourne Faculty and Department/School in which you carried out your PhD project

     

University Faculty/School or Hospital in which you will carry out your Fellowship supported project (if successful)

Clinical Qualifications Are you registered with AHRPA? Yes/No

Email      

Phone      

Current place of work/study/clinic/hospital

PROJECT PROPOSAL

Note that the objectives of the Scheme are to: Provide direct research cost support and/or travel support to an early career researcher-clinician

to enable a 12-month continuation of a neuroscience-related research project that has significant potential to be translational in the medical neurosciences.

To provide a funding source that enables for early career researchers to spend the necessary time thinking and developing their own research program

And included in the evaluation process are: Relevance and potential translatability of the research to the clinic

The degree to which the project is considered to make an impact in neuroscience research Feasibility of project completion within the 12-month period The extent to which the project would be facilitated and accelerated by this fellowship

PROJECT DETAILS

Your two-page proposal should use the following headings.

A. SummaryIncluding: Where you are currently working and/or or studying, role and tenure. Career aspirations for the next 2-5 years. Mention any funding you are currently receiving, and where you plan to conduct the research (over 12 months) should you be successful.

B. Project DescriptionDescription of proposed research project against what has been achieved to date, including evidence of relevance to neuroscience and evidence of a clear and direct link to translation of research results in to the clinic.

What you will achieve with these additional funds?What will you be able to do that you couldn’t previously (i.e.) what gap will you be able to fill?

C. Clinical translatabilityPlease describe the extent to which your research project will be of relevance to and ultimately translatable in to the clinic, including the extent to which the project will make a clinical impact in neuroscience.

D. Expected outcomesDescribe your plans for the communication, dissemination and translation of project outcomes and how you plan to acknowledge receipt of the fellowship should your application be successful.

E. Project budget$23,000 over the period 1 Jan 2019 to 31 Dec 2019Include amount and justification for whatever is applicable from the list below: Travel Consumables Services Salary of support staff (if applicable) Cost of services Other costsIf applicable, please describe and quantify any in-kind contributions from UoM and non-UoM organisations.

It is the applicant’s responsibility to ensure that all cost items are correctly budgeted. Further funds will not be provided for cost over-runs or inadequately budgeted items.

F. Schedule Briefly detail planned activities and milestones for the project over the 12-month period.

G. Other Supporting Documentation (optional) Supporting documentation (e.g.) letters of support.

CVs

Provide a statement of no more than 1 page in total including:

(a) Current position;

(b) Expertise relevant to the proposed project in the current proposal, including track record of prior collaboration and involvement in projects of strong potential for clinical translation and

(c) A representative list of grants and/or refereed publications in areas relevant to the proposal.

REFEREES’ REPORTS

You are required to submit two (2) referees’ reports. Please use the Referees’ Report template provided in the information material on MNI’s website:

http://neuroscience.unimelb.edu.au/research/funding-opportunities

OTHER FUNDING FOR WHICH YOU HAVE APPLIED

You are encouraged to apply for other funding to support your project.

I will also be submitting an application for funding this project to another scheme (provide details) ☐

_________________________________________________________________________________

DECLARATION

In submitting this application, the applicant affirms:

The applicant will hold an academic appointment or an affiliation* with the University of Melbourne running until at least 31st December 2019.

The applicant bears full responsibility for the conduct of the project.

Interim and final reports on the project and its outcomes will be provided to the Director, Melbourne Neuroscience Institute as requested.

__________________________________ _______________________

Signed - Coordinating Investigator Date

__________________________________ _______________________

Endorsed – Head of Department/School Date

of the University of Melbourne in which

you plan to undertake this project

(*) Please note: The term ‘affiliated with’ the University when pertaining to an individual has a special meaning and applies to a member of a formally affiliated body, whereby the affiliated body has entered in to an affiliation agreement with the University and, the staff member of the affiliated body on recommendation of its Head and approval of the University, has been appointed an Honorary position. See the University’s REGULATION 9.60.R1 – AFFILIATED BODIES

Melbourne Neuroscience Institute30 Royal Parade, Parkville, The University of Melbourne, Victoria 3010 AustraliaT: +61 3 8344 1804 | E: info-mni@unimelb.edu.au | W: neuroscience.unimelb.edu.au | unimelb.edu.au