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Application for CORE Support - Version 3 18-01-2023 corrected

Description
Application for CORE Support Instructions: Please complete this form in full and submit by email to Jess Boxall or another member of the CORE team: core@soton.ac.uk CORE eCRF service Clinical Informatics Research Unit Southampton General Hospital Tremona Road Southampton SO16 6YD Tel: 02382027213 Section 1 – Support Required Date: What kind of support does your project require from CORE? (please tick all that apply): Clinical database with CRF’s (ALEA) How many forms? How many data points? Other support: (Please specify) Data management Randomisation (ALEA) Drug supply management (ALEA) Statistics support ePRO (ALEA) Translations required? Writing protocol assistance Funding application advice Database validation Is this part of your PhD or other qualification? Yes No Please tell us how you heard about the Clinical Informatics Research Unit and CORE? Please tell us what organisation you are from? University of Southampton NHS Trust Please specify: BRC Clinical Trials Unit Other organisation: (Please specify) Section 2 – Details of Key Contact Person Title: Prof Dr Mr Mrs Miss Ms Full Name: Job Title: Contact address: Post Code: Tel/bleep: E-mail: Best contact method and day/time: Section 3 – Details of Chief Investigator or tick if same as section 2 Title: Prof Dr Mr Mrs Miss Ms Full Name: Job Title: Employer: Contact address: Post Code: Tel/bleep: E-mail: Best contact method and day/time: Section 4 – Funding Do you already have funding for this proposal? Yes What is the name of your project’s funder? No What is the amount of the grant award? Have you identified a potential funding body? (e.g. HTA, CRC) Yes Which funding body are you considering? Do you have a deadline for your proposed application? Yes, please give date: No No If your grant has been successful, what organisation is holding your funds? NHS Trust UoS Please specify: If University of Southampton, please provide the grant code: Section 5 – Research Proposal Outline (Please provide as many details as possible) Title of Research Proposal : Summary of proposal: Observational Phase I Phase II Phase III Phase IV Is the proposal Interventional or Observational? What is the proposal’s duration e.g. years? What are the current estimated total sample size and number of sites? Is the proposal national or international? If a statistician has been involved in the design, please include details of the planned analyses, including frequency and plans for subgroup analyses, otherwise leave blank. Name of Statistician: Organisation of Statistician: Contact details of Statistician: Details of planned analyses: Planned start date (please specify any deadlines): Other comments or relevant information: Thank you for your application. You should receive an acknowledgement of receipt within 2 working days. For internal use only: Application no.: Review date deadline: Date received: Date acknowledged: Review outcome: Date notified of outcome: CORE Application for Support v3 18-Jan-2023 Page 1 of 3
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/Media/Southampton-Clinical-Research/Downloads/Application-for-CORE-Support-Version-3-18-01-2023-corrected.docx

Research Engagement Internship Application Form September 2021

Description
UHS Research Engagement Internship 2022 – Application Form Section 1 – To be completed by the Applicant Name: Click or tap here to
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/Media/Southampton-Clinical-Research/Downloads/Research-Engagement-Internship-Application-Form-September-2021.docx

BRC - Education, Training and Career Development Fund - Application form 202309

Description
For Biomedical Research Centre (BRC) Education, Training and Career Development Fund The NIHR Biomedical Research Centre (BRC) Education, Training and Career Development Fund will support individuals undertaking research in areas related to the BRC themes of Nutrition, Lifestyle and Metabolism, Respiratory and Allergy, Data Health and Society, Microbiology Immunology and Infection, and Perioperative and Critical Care. The research should be aligned with, but not necessarily funded by, the research themes, aims and SMART objectives of the BRC. Funding is for a maximum of £1,000 in a 12-month period. The fund primarily aims to support training needs of researchers in the early phases of their career, or research support staff with training and development needs. It will also, in exceptional circumstances, support senior staff if their training and development needs cannot be met elsewhere (e.g. NHS Consultants invited to present BRC-supported research at international meetings). Affiliation with and funding from the BRC must be acknowledged in presentations and open-access publications. Applicants must be staff or students of University of Southampton or University Hospital Southampton NHS Foundation Trust. NB: Funding applications from people with a BRC-funded fellowship who already have provisions for training and development will not be prioritised. If successful, you will be required to provide feedback on how this funding opportunity has impacted your learning and development. (A feedback form will be sent after your claim has been processed). Examples of support include: * Conference fees (please note that conference fees will only be awarded to either presenting authors (evidence of abstract acceptance required), or to staff where attending the conference would meet specific learning needs (please explain in application)) * Travel to other centres * Open-access fees * Short course fees We do not support: * Research which falls outside the remit of the BRC * Salaries * Stipends * Living expenses * Projects * Mandatory training and development * University fees for higher degree * Expenses which can be accessed from other sources (e.g. NIHR ACFs and CL with access to travel funds). * Individuals who have alternative access to funds, e.g. NIHR Academy members who, by virtue of having been awarded an NIHR Southampton BRC studentship / fellowship, already have a budget for training as part of their studentship/ fellowship, or those eligible to apply for funding via an NIHR trainee fund. Please apply by email to BRC@uhs.nhs.uk Please attach: * A short CV (no more than 2 pages) * A brief letter of support from your supervisor (students) or from your line manager (postdocs or other staff members) * This application form, including the justification (maximum 250 words) Applicant details Name: Contact address: Current position: Since: Higher degree registered for (if appropriate): Since: Email: Mobile no: Title and name of supervisor or line manager: Supervisor’s email address: The following information is used for financial purposes only and acts as a guide of which route to follow when claiming. Please select one of the following options below. Who is your primary employer? This is the organisation name which reflects in your payslip. Staff member UOS: Yes No Staff member UHS: Yes No If you are not employed by one of these organisations and you are currently pursuing a qualification through the UoS please select the option below. Student UOS: Yes No Other (details): Summary of request Total funding cost: Date of when is funding needed: Breakdown of funding requested (max £1000). Please mention additional sources of funding if relevant. Justification Please explain briefly (maximum 250 words) why the funding is required and how it will be used. You could include the following: * How you are contributing to the BRC’s research * A brief description of your training or development need and how this fund will help meet it * How the funding will contribute to your future research and/ or career * What funding is already in place (if any) * Justification for the cost (attach quotes if applicable) * How this funding will benefit BRC and the care of patients in the future Previous BRC support Please provide details of any previous support from the BRC / Respiratory BRU that you AND your supervisors have received. Include the outcome of this support (e.g. £250 for course that provided knowledge to undertake a systematic review which been published, presented poster at international conference, preliminary data for external grant application, etc). For all outputs please confirm that NIHR BRC / BRU was acknowledged. Title and date of previous support: Nature of the award(s): (e.g. course fees, travel support) Outcome of award(s) (e.g. list of poster presentations or publications, explanation of how your work has improved): Signatures Successful applicants agree to: * Support the BRC, depending on your circumstances and skills (e.g., give a short talk at a BRC training meeting, organise a BRC training meeting) * Acknowledge the BRC on all publications and presentations resulting from this funding. Please inform BRC of all such research outputs * Provide feedback on how this funding opportunity has impacted your learning and development Claim the award within 3 months of receiving the award letter Applicant’s signature x Date: Supervisor / line manager’s signature Date: Please apply by email to BRC@uhs.nhs.uk Please ensure that you have attached the following documents to your email: * A short CV (no more than 2 pages) * A brief letter of support from your supervisor (students) or from your line manager (postdocs or other staff members). * This application form, including the justification (maximum 250 words) Failure to do so will result in your application being rejected.
Url
/Media/Southampton-Clinical-Research/Downloads/BRC-Education-Training-and-Career-Development-Fund-Application-form-202309.docx

UHS RLP Cohort 5 Application Form - For reference only

Description
UHS Research Leaders Programme, Cohort 5 https://forms.office.com/Pages/DesignPageV2.aspx?prevorigin=Marketing&origin=NeoPortalPage... UHS Research Leaders Programme, Cohort 5 Please refer to our online Guidance notes whilst completing this application. Please ensure that once you submit this application, you follow it up with annexes A&B to be emailed to RLP@uhs.nhs.uk before the deadline. Incomplete applications will not be accepted. 1 of 7 * Required Applicant Details: 1. Name: * 2. Email: * 3. Highest degree held: Year awarded: Awarding institution: * 07/08/2024, 11:21 UHS Research Leaders Programme, Cohort 5 4. Title of your Current post : * https://forms.office.com/Pages/DesignPageV2.aspx?prevorigin=Marketing&origin=NeoPortalPage... 5. Speciality (if applicable) 6. Manager's Name: * 7. Care Group * 8. Division (A, B, C, D or Trust HQ) * 9. Name of your Divisional Clinical Director: * 10. Professional group and banding/grading: * 11. Current Whole Time Equivalent (WTE)/ Programmed Activity (PA) of UHS employment contract * 2 of 7 07/08/2024, 11:21 UHS Research Leaders Programme, Cohort 5 https://forms.office.com/Pages/DesignPageV2.aspx?prevorigin=Marketing&origin=NeoPortalPage... 12. Do you have any WTE/PAs funded for research activity? * Yes No 13. If you answered yes to Q12, Please detail amount in WTE or number of PAs and source of funding (i.e UHS R&D, grant income, university, other) * 14. Funded time requested from RLP in WTE or PAs * 15. Final Overall WTE/PA including RLP funded time * 16. Please provide a brief breakdown from Question 15 * 3 of 7 07/08/2024, 11:21 UHS Research Leaders Programme, Cohort 5 https://forms.office.com/Pages/DesignPageV2.aspx?prevorigin=Marketing&origin=NeoPortalPage... Award Details: 17. Research Advisor Name and Title: * 18. Number of months of funding requested from RLP: * 19. Please indicate which Fellowship Model: * Group A - Clinical Research Delivery Group B - Clinical Academic Mixed - Exceptional circumstances with prior discussion only 20. Do you anticipate requiring funding to support you to complete the NIHR Credentialing PGCert or equivalent? * Yes No 4 of 7 07/08/2024, 11:21 UHS Research Leaders Programme, Cohort 5 https://forms.office.com/Pages/DesignPageV2.aspx?prevorigin=Marketing&origin=NeoPortalPage... 21. Why are you applying for the UHS Research Leaders Programme? (500 Words) Please detail any outputs from previous research experience and training, relative to your career stage and background, your suitability for and commitment to a career in research, your potential to become a future leader in research, and how you feel the RLP will help you to fulfil these goals. * 22. What qualities do you feel make a good leader? How do you align with these, and how might you develop your leadership skills further? (250 Words) * 23. Applicants for Group A and Mixed only: Please detail your experience of research delivery to date, and any studies that you anticipate supporting during the initial RLP period (if known). Please detail if these are commercial or non-commercial. (250 Words) 24. Applicants for Group B and Mixed only: Please list your most significant publications over the last 2 years (max 10) and any others that are relevant to this application. For each, please detail your role in the publication e.g. collated data, contributed to paper, lead author etc. 25. Please specify any current grants held and your role: For each, please detail: Date awarded, Project Title, Funding Body, Role (CI, Co-Applicant etc) ,amount (£) and indicate whether project has been completed or is ongoing. 5 of 7 07/08/2024, 11:21 UHS Research Leaders Programme, Cohort 5 https://forms.office.com/Pages/DesignPageV2.aspx?prevorigin=Marketing&origin=NeoPortalPage... 26. Please outline your objectives for this fellowship, and your training and career development programme (500 words) Where do you see yourself at the end of this award if successful, and in 5 years’ time? How will you make use of the training and career development opportunity of the RLP in order to achieve these goals? * 6 of 7 07/08/2024, 11:21 UHS Research Leaders Programme, Cohort 5 https://forms.office.com/Pages/DesignPageV2.aspx?prevorigin=Marketing&origin=NeoPortalPage... 27. How will you make use of the RLP fellowship, in order to achieve these outcomes and how does this align with the Trust research objectives? (250 words) Please detail a clearly articulated plan to achieve the outcomes you wish to achieve by the end of the RLP Fellowship, and how the award will support an application for future funding. * 28. Please describe the anticipated sources of funding to support your career progression post RLP funding: * 29. Please confirm that you have sent the following supporting documentation to RLP Team: * Annex A: Research Advisor Support Statement Annex B: Manager Support Statement This content is neither created nor endorsed by Microsoft. The data you submit will be sent to the form owner. Microsoft Forms 7 of 7 07/08/2024, 11:21
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/Media/Southampton-Clinical-Research/Downloads/UHS-RLP-Cohort-5-Application-Form-For-reference-only.pdf

Application Form open call 2020-2021

Description
For Biomedical Research Centre (BRC) in association with Southampton Academy of Research (SoAR) Education, Training an
Url
/Media/Southampton-Clinical-Research/SoAR/Application-Form-open-call-2020-2021.docx

NIHR BRC Education and Training Fund Application Form

Description
For Biomedical Research Centre (BRC) in association with Southampton Academy of Research (SoAR) Education, Training an
Url
/Media/Southampton-Clinical-Research/Downloads/NIHR-BRC-Education-and-Training-Fund-Application-Form.docx

AMS FLIER summary 2022 - cohort 3 applications open

Description
Future Leaders in Innovation, Enterprise and Research (FLIER) Programme The Academy of Medical Sciences is pioneering a unique programme to d
Url
/Media/Southampton-Clinical-Research/Grants/AMS-FLIER-summary-2022-cohort-3-applications-open.pdf

BRC EDI Prize Application Form_November 2025

Description
BRC EDI Prize Application Form Please complete the form and submit to brc-applications@uhs.nhs.uk by 12:00 midda
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/Media/Southampton-Clinical-Research/Downloads/BRC-EDI-Prize-Application-Form-November-2025.docx

RA Clinical Academic application form Nov 2023

Description
NIHR Senior Clinical Academic Career Development NIHR Southampton BRC Respiratory and Allergy Research Theme The NIHR Southampton
Url
/Media/Southampton-Clinical-Research/Downloads/RA-Clinical-Academic-application-form-Nov-2023.pdf

Research Fellow Application Form

Description
Clinical Research Network Wessex Research Fellow Application Form 2018/19 Please do not alter the formatting of this form or delete
Url
/Media/Southampton-Clinical-Research/SoAR/Research-Fellow-Application-Form.docx
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