Pioneer Research Award Application Form

ESCRS Pioneer Research Award (PRA) Application Form

Principal Investigator (PI) Details

Name(Required)

Email(Required)

Institution/Hospital(Required)

Current position(Required)

Academic Qualifications (1000 characters max)(Required)

Years in practice / research(Required)

Co-investigator details

Co-investigator 1 name

First Last

Co-investigator 1 email

Co-investigator 1 Institution/Hospital

Co-investigator 1 Current position

Co-investigator 2 name

First Last

Co-investigator 2 email

Co-investigator 2 Institution/Hospital

Co-investigator 2 Current position

Details of any other investigators/collaborators

Project Information

This entire section should amount to no more than four A4 pages, word limits are provided

Title of Research Project(Required)

Abbreviated title(Required)

Please include at least 4 keyterms that are relevant to your project*(Required)

Project durations (in months)(Required)

Projected start date(Required)

Project Summary (250 words max)(Required)

Research Question / Objective (200 words max)(Required)

Background and significance (400 words max)(Required)

Methodology (400 words max)(Required)

Timeline (key milestones)(Required)

Expected outcomes (200 words max)(Required)

Site qualification (200 words max)(Required)

Feasibility justification (200 words max)(Required)

Dissemination plan (e.g. journal submission, conference presentations, podcasts, etc.) (200 words max)(Required)

If you wish to upload a Gantt chart and/or your budget as a spreadsheet then please do so here. This is not mandatory and no other files will be reviewed.

Max. file size: 300 MB.

Budget

Total funding requested (in €)(Required)

Detailed budget breakdown (e.g. consumables, personnel time, clinical time release, equipment, travel)(Required)

Other sources of funding (if any)(Required)

Other Declaration of Interests (include any declaration of interests relevant to your project) of funding (if any)(Required)

Declarations

By submitting this form you confirm that(Required)

The information provided is accurate and complete

You are authorised to submit the application on behalf of the proposed project team

The lead investigator is a legal entity capable of entering into a contract with ESCRS

You agree to ESCRS's data and ethical guidelines for research

You agree with the ESCRS Grant Agreement Terms (link provided on grant information page)

You hold a full-time or affiliated post with an established clinical or research institute named above, who have agreed to act as Sponsors for the research proposed and have the expertise required to support the administrative, insurance and regulatory requirements necessary for the conduct of this study;

You consent for ESCRS and its administrative partners to store and process your data contained within the application

You understand that any ownership of any intellectual property arising from the project will be subject to agreement between the sponsoring institution and ESCRS prior to the commencement of funding, in accordance with the ESCRS Intellectual Property policy