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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:    
  Town:    
  County:    
  *Postcode:    
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)

Item Amount
Salaries (inc NI and superannuation)
Consumable Items
Equipment
Travel and Subsistence
Other
   
B4
*Please explain how your application fits the terms and conditions for pump priming grants

(Up to a maximum of 1000 characters, approximately 200 words)
      
B5 *Please provide a brief summary of your proposed project
(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)
      
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
        
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