MAPPING QUESTIONNAIRE TO INFORM THE Web viewMrs Karen Ford, Chief Scientist Office, GE15, ......
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NRS – delivering research excellence NRS Career Researcher Fellowships Application Form 2013 Please read the guidance document carefully before completing this application form, in particular the question-specific guidance. Completed forms should be submitted to: Mrs Karen Ford, Chief Scientist Office, GE15, St Andrews House, Regent Road, Edinburgh, EH1 3DG ([email protected]) Forms should be submitted electronically to the email address above by no later than noon on Friday 8 th November 2013 with signature page(s) forwarded in hard copy. Section A: your details Name: Qualifications: Current position: Start date in current position * : Date of first appointment as substantive consultant: * For applicants who work (or since taking up a substantive consultant post have worked) less than full time please indicate the total whole time equivalent duration since taking up a substantive consultant post 1
Transcript of MAPPING QUESTIONNAIRE TO INFORM THE Web viewMrs Karen Ford, Chief Scientist Office, GE15, ......
NRS – delivering research excellence
NRS Career Researcher Fellowships
Application Form 2013
Please read the guidance document carefully before completing this application form, in particular the question-specific guidance.
Completed forms should be submitted to:
Mrs Karen Ford, Chief Scientist Office, GE15, St Andrews House, Regent Road, Edinburgh, EH1 3DG ([email protected])
Forms should be submitted electronically to the email address above by no later than noon on Friday 8th November 2013 with signature page(s) forwarded in hard copy.
Section A: your details
Name:
Qualifications:
Current position:
Start date in current position*:
Date of first appointment as substantive consultant:
Employer:
Contact details (Email and Tel):
Section B: Employment History
Employe Position Responsibilities Start End date* For applicants who work (or since taking up a substantive consultant post have worked) less than full time please indicate the total whole time equivalent duration since taking up a substantive consultant post
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r date
(please expand table as necessary).
Section C: Research history
1. Please list any research projects you have been involved in:
Project title Start/ end dates
Funder (if applicable)
Grant Value (if applicable)
Role
(please expand table if necessary)
2. Publicationsa. Please list the total number of publications on which you are
an author b. On how many of these publications were you the first author?c. List your 5 best peer reviewed publications or all publications
if the total is less than 5.
a.b.
c.
3. Please describe why you are applying for this Fellowship and the benefits to your career (max 500 words)
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4. Please briefly describe any previous experience of supervising student clinical research projects.
5. Please list any intellectual property to have emerged or in progress from your research e.g. patents
6. Please list any other outputs from research you have been involved in such as examples of knowledge transfer and impacts on patient care (max 250 words.
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Section D: Justification for request
7. Please specify the title of your proposed Research Programme
8. Please describe your proposed Research Programme (max 1500 words).
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9. Please describe how your proposal is relevant to current NHS policy in your clinical area (max 300 words)
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10. Please describe how any outputs from your proposed Research Programme will influence patient care and/or impact on the health and wellbeing of patients (max 500 words)
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11. Please describe which area(s) of NRS research excellence your proposal is aligned to OR the ‘orphan’ area in which you propose developing research (max 250 words)
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Section G: Clinical Support
12. Please detail your current job plan (include details of any sessions currently earmarked for research) and how the requested research sessions would be incorporated
13. Please describe how your Clinical Department would ensure that your NRS Career Researcher Fellowship time is ringfenced for research and any additional benefits offered e.g. additional support. This should include details of how your clinical sessions will be backfilled. (max 250 words)
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14. Please describe how you would spend your protected time if awarded an NRS Career Researcher Fellowship eg writing grants, recruiting patients etc (max 500 words)
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Section H: Research Environment and Academic support
15. Please specify an NHS mentor
16. Please describe how the mentor will support your development as a Researcher within the NHS (max 250 words)
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17. Please describe the research environment your Research Programme would take place in and how your proposal fits with existing research in the clinical department (max 250 words)
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18. If appropriate please specify a HEI Partner organisation
19. Please describe any additional benefits offered by the partner HEI eg training, additional support, Honorary lecturer/senior lecturer position (max 250 words)
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20. Please describe the research training course(s) you propose attending and the relevance to your research programme.
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Section I: details of post and/ or funding requested
17. Financial details
Post Title Band/Grade
W.T.E. requested
Proposed Start Date
Proposed End Date
FundingYear 1 (2014/15)
FundingYear 2 (2015/16)
FundingYear 3 (2016/17)
Total funding requested
18. Metrics of success – please outline the proposed key metrics against which your success can be measured throughout, and at the end of, the Fellowship (eg grants obtained, studies completed, papers published, student supervision)
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Section J: Declarations/ Signatures
a. Applicant – by signing below I confirm that the details provided in the form are accurate.
Name…………………………………………………. ....................................... Signature ………...…………………………………………………………………………………. Position……………………………………………….........................................Date ………………………...........
b. Clinical Director – by signing below I confirm that, if this application is successful, the time requested in Section I will be ringfenced for the Fellowship
Name…………………………………………………. ....................................... Signature ………...…………………………………………………………………………………. Position……………………………………………….........................................Date ………………………...........
c. Mentor - confirmation of support
Name…………………………………………………. ....................................... Signature ………...…………………………………………………………………………………. Position……………………………………………….........................................Date ………………………...........
d. HEI Head of Department – by signing below I confirm support for this application
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Name…………………………………………………. ....................................... Signature ………...…………………………………………………………………………………. Position……………………………………………….........................................Date ………………………...........
Thank you for completing this application form
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