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TKI-LSH (Match) PPP-allowance application form 2017


Basic details


1A. Full project title:
1B. Project acronym (if applicable):

2. Contact details of main applicant (‘project coordinator’)
Consortium partner 1

- Name of organisation:

- Department:

- Name of contact person, title(s):

- Male/female:

- Position:

- Address for correspondence:

- Telephone:

- E-mail:

- Health fund/company/research organisation/other

- SME (MKB): Yes/No

- If you are an SME, please indicate if you are a medium-sized, small or micro enterprise (for SME definition see Appendix A):

- Chamber of commerce number or equivalent:

- URL of own web page:

- (Scientific) excellence and expertise of the main applicant and added value of the main applicant to the quality of the project:

- Benefit of this project for the main applicant:

3. List of consortium partners (co-applicants)
Consortium partner 2

- Name of organisation:

- Department:

- Name of contact person, title(s):

- Address for correspondence:

- E-mail:

- Health fund/company/research organisation/other

- SME (MKB): Yes/No

- If you are an SME, please indicate if you are a medium-sized, small or micro enterprise (for SME definition see Appendix A):

- Chamber of commerce number or equivalent:

- URL of own web page:

- (Scientific) excellence and expertise of the consortium partner and added value of the consortium partner to the quality of the project:

- Benefit of this project for the consortium partner:
Consortium partner 3

- Health fund/company/research organisation/other

- Name of organisation:

- Department:

- Name of contact person, title(s):

- Address for correspondence:

- E-mail:

- Health fund/company/research organisation/other

- SME (MKB): Yes/No

- If you are an SME, please indicate if you are a medium-sized, small or micro enterprise (for SME definition see Appendix A):

- URL of own web page:

- Chamber of commerce number or equivalent:

- (Scientific) excellence and expertise of the consortium partner and added value of the consortium partner to the quality of the project:

- Benefit of this project for the consortium partner:
Etc.

4. Consortium agreement and IP

Please describe the main aspects of the consortium agreement and the anticipated plan regarding intellectual property (IP) generated by the project.

5. Start date (dd-mm-yyyy):

6. Duration of the project (months):


Project content


7A. Public summary (max. 200 words, in lay language)

7B. Public summary in Dutch (max. 200 words, in lay language)

8. Research category (see Appendix B)

Please indicate the applicable type(s) of research (more than one option possible).


Types of research

yes/no

  1. Fundamental research




  1. Industrial research




  1. Experimental development






9. Applicable roadmaps (see Appendix C)

Please indicate which roadmap(s) is/are most applicable to the project (max. 2 roadmaps).


LSH Roadmaps

yes/no

  1. Molecular diagnostics




  1. Imaging & image-guided therapies




  1. Homecare & self-management




  1. Regenerative medicine




  1. Pharmacotherapy




  1. One health




  1. Specialized nutrition, health & disease




  1. Health technology assessment & quality of life




  1. Enabling technologies & infrastructure




  1. Global health, emerging diseases in emerging markets






10. Summary of the project

Please provide a concise summary of the project (max. 3000 words) and include 5-10 relevant literature references. Insert citations in superscript (after punctuation) and list the references under point 11 in numerical sequence in the order in which they are first mentioned in the text.

Items to be included:

  1. Research topic, background, objectives, hypothesis.

  2. Outline workplan per workpackage (if more than one) in a table or scheme, including: time schedule, milestones and deliverables. Indicate the role and responsibilities of the applicants in the activities.

  3. The coherence between the workpackages (if more than one).

  4. The expected scientific, societal and economic (also for the company) impact of the project per deliverable.

  5. The current and expected Technology Readiness Level (TRL; see Appendix D) of the project (level of development/readiness to go to the market).

  6. The planned activities in order to promote the dissemination and implementation of the results.


If applicable, the full project description may be attached for reference (e.g. in case you have applied for another grant as well).

11. Please provide a concise list of references

List all authors when there are six or less; when there are seven or more, list the first three, then 'et al'. Avoid using the words 'in press' in references if possible.

12. Relevance of the project

  1. Please describe how does the project fits within the Knowledge and Innovation Agenda 2016-2019 (max. 300 words).

  2. Please indicate how the project contributes to (one of) the main objectives of the Top Sector LSH (max. 200 words):

  1. maintain health and functioning (prevention)

  2. maximize effect/minimise burden (cure)

  3. manage health and disease extramurally (care)

  1. Please indicate which activities will be financed through the PPP-allowance.



13. Originality/innovativeness

Please describe the originality of innovativeness of the project. What is new and unique? What are the novel clinical applications?

14. Risks of the project

Are there any risks regarding the execution of the project? If so, how will this be handled?

Human subjects, laboratory animals, biological hazards


15. Will the project involve experiments with patient material?





Answer

  1. Use of healthy volunteers?

yes/no

  1. Use of patients?

yes/no

  1. Number of healthy volunteers




  1. Number of patients




  1. Is ethical approval from a commission needed regarding experimental subjects?

yes/no/NA

  1. If ‘d’ is answered with ‘yes’: Do you already have ethical approval from a commission to perform the study?

yes/no/requested/NA



16. Will the project involve experiments with animals?





Answer

  1. Use of animals?

yes/no

  1. What kind of animals are used?




  1. Number of animals needed per year




  1. Nature of intervention




  1. Is ethical approval from a commission needed regarding experimental subjects?

yes/no/NA

  1. If ‘d’ is answered with ‘yes’: do you already have ethical approval from a commission to perform the study?

yes/no/requested/NA



17. Justification for the requirement of experimental animals

  1. Indicate if alternative methods (besides experimental animals) have been considered? Have experts been consulted and has a systematic review been performed?

  2. What are the reasons that this project cannot be performed without experimental animals (replacement)?

  3. What are the reasons that this project cannot be performed with fewer animals (reduction) or with less distress and discomfort for the animals (refinement)?

  4. What are the reasons that this project cannot be performed with a lower species of animals?



18. Will the project involve biological risks?





Answer

  1. Use of recombinant DNA?

yes/no

  1. If ‘a’ is answered with ‘yes’: provide class of recombinant DNA




  1. Use of radiation (wave and/or particle)?

yes/no

  1. Use of radioactive isotopes?

yes/no

  1. Use of pathogenic micro-organisms?

yes/no

  1. Are required grants, permits and facilities available?

yes/no/NA



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