You can review your answers here. If you are happy with your application, click Complete to submit.
Click Review to return to your form and make any changes.
PLEASE NOTE : Once you have clicked the Complete button you will not be able to make any further amendments to your application.
| A1 |
*Your organisation name
If you are applying from a private practice, please ensure you provide the information re ethical approval requested at question B7. |
|||||||||||||||
| A2 | Your organisation address | *Address1: | ||||||||||||||
| Address2: | ||||||||||||||||
| Address3: | ||||||||||||||||
| Town: | ||||||||||||||||
| County: | ||||||||||||||||
| *Postcode: | ||||||||||||||||
| Country: | ||||||||||||||||
| A3 |
*Your name (title, first name, surname)
If the PI has yet to be appointed, the supervisor will be the main contact. If this is the case please put "TBA" in questions A3 and A4 and the supervisor's email in A5. |
|||||||||||||||
| A4 |
*Please provide qualifications
|
|||||||||||||||
| A6 |
*Name of Supervisor
Please provide the name of the person who will be supervising this project |
|||||||||||||||
| A5 |
*Your email address
(This email address will be used to send you an acknowledgement and a copy of your application form when you have finished your application.) |
|||||||||||||||
| A7 |
*Email address of supervisor
|
|||||||||||||||
| A8 |
*If you have had previous funding from Petplan Charitable Trust, please list
Please list grant number, amount and outcome (publications, further grants). If none please put NONE |
|||||||||||||||
| A9 |
Please list any other grants currently held by you (main applicant)
|
|||||||||||||||
| A10 |
Please list recent publications (no more than 5)
|
|||||||||||||||
| B1 |
*Title of project
|
|||||||||||||||
| B2 |
*What is the total expected cost of the project (including VAT)?
|
|||||||||||||||
| B3 |
*Breakdown of funds you are requesting (up to a maximum of £12,500)
|
|
||||||||||||||
| B4 |
*
Please explain
a) how your application fits the terms and conditions for pump priming grants
b) how you meet the requirements for receiving a pump priming grant - NB applicants should be new to research (Up to a maximum of 1000 characters, approximately 200 words) |
|||||||||||||||
| B6 |
*Please briefly describe anticipated research outcome of this project and potential further studies
(You can enter a maximum of 250 characters - approximately 50 words) |
|||||||||||||||
| B5 |
*Please provide a brief summary of your proposed project
(Up to a maximum of 1000 characters, approximately 200 words) |
|||||||||||||||
| B7 |
*Please list all those who will be collaborating on this project (including qualifications and institution)
PLEASE NOTE : Applicants in private practice MUST provide written ethical approval for the proposed study from the RCVS - please attach to this application form |
|||||||||||||||
| B8 |
*Please provide a more detailed description of your research project together with justification for the resources requested.
(You can enter a maximum of 4000 characters, approximately 800 words) |
? | ||||||||||||||
| B9 |
Please confirm that you have read and will comply with the Trust's terms and conditions for this grant
Failure to confirm will result in the application being rejected. |
|||||||||||||||
| C1 |
If you have any images you wish to include to support your application, you may upload them here. Please note that multiple images will need to be collated into one file before uploading.
Reuploading a file overwrites the currently uploaded file |
|||||||||||||||
|
If your application is complete, please click on the REVIEW button and follow the instructions to submit.
If you wish to return to your form before submitting it, please click SAVE AND EXIT |
||||||||||||||||
|