For Official Use Only
PROGRAMME NAME
Irish Cancer Society-SFI Collaborate Cancer Research Centre
TITLE OF PROPOSAL (up to 30 words)
Enter text here
FULL NAME OF LEAD APPLICANT
Enter text here
HOST INSTITUTION
Enter text here
TOTAL REQUESTED BUDGET (€)
Enter text here
TOTAL INDUSTRY CASH
CONTRIBUTION (€)
Enter text here
PROPOSED DURATION
60 Months
REQUESTED STARTING DATE
01/01/2015
Signatures below confirm acceptance and agreement with the SFI grants and awards
Terms and Conditions, and that the institution ensures the applicant meets eligibility
requirements, and that the project is in full agreement with all legal and regulatory
matters governing research in Ireland, and no aspect of this project is already being
funded from another source and all details provided are correct.
INSTITUTIONAL SIGNATORY
TECHNOLOGY TRANSFER OFFICE
AUTHORITY
Name:
Name:
Position:
Position:
Email:
Email:
Signed:
Signed:
Date:
Date:
Comment from TTO Director/Officer
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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Irish Cancer Society Remit Justification (max. 250 words)
Applicants are required to complete a brief statement justifying how the application aligns
with the strategy of the Irish Cancer Society, as outlined in its “Towards a Future without
Cancer” Strategy Statement 2013-2017. The statement must describe the potential societal
impact of the proposed research to both cancer patients and the public. For further
information of the Irish Cancer Society’s “Towards a Future without Cancer” Strategy
Statement 2013-2017.
SFI Remit Justification (max. 250 words)
Applicants are required to complete a brief statement justifying that the application is within
SFI’s legal remit. The statement must describe how the proposed research is oriented basic or
applied research which promotes or assists the development and competitiveness of industry,
enterprise and employment in Ireland. For further information on SFI’s legal remit can be
found on the SFI website
Eligibility Criteria
Applicants are required to confirm that they have read and understood the eligibility criteria described
in the call document, and confirm that they are eligible to apply to this call.
Please confirm that you have read and understood the eligibility criteria in the relevant
☐
call document, and that you are eligible to apply to this call?
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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IRISH CANCER SOCIETY-SFI COLLABORATIVE CANCER RESEARCH CENTRE
STAGE 1- PRE-PROPOSAL APPLICATION FORM
[INSERT CENTRE TITLE]
************************
IMPORTANT NOTICE: The CALL DOCUMENT must be read carefully before
completing this Stage 1 - Pre-Proposal Application Form
************************
1.
Contact Details
Lead Applicant
Lead Applicant
Title and Name:
Institution:
Position:
Email:
Telephone Number:
Correspondence Address:
% Time Commitment:
Co-Applicant
Co-Applicant
[copy table as required (max. 9 Co-Applicants)]
Title and Name:
Institution:
Position:
Email:
Telephone Number:
Correspondence Address:
% Time Commitment:
Official Collaborators
Official Collaborator
(copy table as required)
Title and Name:
Institution:
Position:
Email:
Telephone Number:
Correspondence Address:
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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2.
Collaborative Centre Summary
2.1
Scientific Abstract (max. 250 words)
2.2
Lay abstract (max. 250 words)
2.3
Research Theme (max. 100 words)
2.4
Keywords
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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3.
Collaborative Centre Research Group
3.1 Profile of the Applicant Group and Proposed Collaborative Structure (max. 2 pages)
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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4.
Research Programme
4.1 Research Programme Description (max. 5 pages)
4.2 References
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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5.
Impact Statement and Industry Engagement Plan (max. 5 pages)
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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6.
6.1
Budget Summary
Overall Collaborative Centre Budget
Table 1. Total Centre Budget
Irish Cancer Society-SFI Collaborative Cancer Research Centre
Year 1
Year 2
Year 3
Year 4
Year 5
Total
Industrial Cash
-
Industry In Kind
Contribution
Requested Irish
Cancer Society-SFI
Contribution
TOTAL CENTRE
BUDGET
6.2
-
-
-
-
-
-
Indicative Budget (max. 2 pages)
Table 2. Indicative Budget
Irish Cancer Society-SFI Collaborative Cancer Research Centre
Year 1
Year 2
Year 3
Year 4
Year 5
A. Staff
i) Salaries (including PRSI, Pension)
ii) Student Stipends
iii) Student Fees
Total Staff Costs
B. Materials
C. Equipment
D. Travel
Total (B + C + D)
€
€
€
€
€
€
€
€
€
€
Yearly Grand Totals
€
€
€
€
€
Grand Total of Centre
€
6.3
Budget Breakdown by Research Programme Area
Table 3. Budget Breakdown by Research Programme Area
Irish Cancer Society-SFI Collaborative Cancer Research Centre
Year 1
Year 2
Year 3
Year 4
Year 5
€
€
€
€
Research Programme 1
Research Programme 2
Research Programme 3
Research Programme 4
Total Direct Costs
Total
€
€
€
€
€
€
*Insert additional rows as required
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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6.4
Budget Justification (max. 1 page)
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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6.5
Funding History
Table 4. Funding History
Name of
Applicant / CoApplicant
Grant
Title
Grant
Code
Total
6.6
Granting
Body
Award
Date
Total Grant
Value
Applicant / CoApplicant Share
€X
€Y
Other sources of funding
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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7.
Letters of Support
Summary Breakdown of Industry Partner Contribution
INDUSTRY PARTNER “X” CONTRIBUTIONS
Year 1
Year 2
Year 3
Year 4
Year 5
Total
Cash Contribution
Staff Contribution
Equipment Contribution
Other In-Kind Contribution
Summary of Official Collaborator Contribution
OFFICIAL COLLABORATOR
Collaborator
Collaborating
Name
Institute
Area of
Expertise
Contribution to Collaborative Centre
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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8.
Signature Pages
Collaborative Cancer Research Centre Pre-proposal Signature Pages
Page 1 of 2
Irish Cancer Society Collaborative Cancer Research Centre
Title of Proposal:
Name of Lead Applicant:
Signed by Lead Applicant:
Date:
Name of Participating Institution:
Authorised Signatory of Research Institution of Lead Applicant
Name:
Position:
Email:
Address:
Signed:
Date:
Institutional Stamp:
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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Collaborative Cancer Research Centre Pre-proposal Signature Pages
Page 2 of 2
Co-Applicant Signatures
Name 1:
Signature:
Name 2:
Signature:
Name 3:
Signature:
Name 4:
Signature:
Name 5:
Signature:
Name 6:
Signature:
Name 7:
Signature:
Name 8:
Signature:
Name 9:
Signature:
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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Appendix A – Curricula Vitae
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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Appendix B – Letters of Support
Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form
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