Prior to commencing your application please ensure:
1. Your Host Institution has read and agreed the Terms & Conditions under which any offer of Grant Award will be provided.

2. You have collected the following information from your Host Institution Legal or Financial Representative or both if your institution requires and submitted with your application as a PDF attachment. Download this form, complete it fully and return as an attachment below in PDF format.

3. Your application WILL NOT be considered without 2 above having been submitted in the following format on this application.

Please complete all the fields.

1. Details of principal applicant
Details of UK-based co-applicants.

Name: Full title, all initials
and last/family name

Institution

Present position of Principal Applicant

Contact address

Telephone

Your Email (required)

Co-applicant names: Use
full titles, all initials and
last/family name, Institution and position. Please separate each co-applicant with a blank line.

2. Project Details

Title of project ((please give full title and preferred 1–3 word abbreviation))

2a. Length of project (in months)

2b Project start date dd/mm/yy

2c Project end date dd/mm/yy

3. Briefly describe the aims of this project using non-technical terminology (maximum 200 words). Please note that this section may be seen by non-scientists

4. Please describe the relevance of this project and say how it fits with Histio UK research goals and objectives. (maximum 200 words)

5. Describe patient or public involvement (maximum 200 words). It is advantageous that you have involved or plan to involve patients or members of the public in the research process e.g., prioritisation of the research focus, design or execution of research.

6. Research plan (maximum 1500 words). Please address the following: a) Rationale; b) Aims; c) Approach and experimental methods; d) Outcome.

7. Impact (maximum 200 words). Outline the likely impact of your work on the field including timeline. It is advantageous if you have plans to develop the work into bids for Research Council funding

8. Estimated costs (please note that the charity does not cover overheads)

Salary

Consumables

Equipment

Total

9. Justification of costs (max 200 words)
For each category, describe how the funding will be spent and why this is critical to the delivery of the research.

10. Please list up to 5 most relevant publications for the principal applicant

11. Active research grants. Please list currently active grants and describe if/how they relate to the current proposal. Give the name of funder, value and reference number(s).

12. Related applications. If you have applied for funding from other sources for this proposal, please give the name of funder, value, reference number(s) and status of the application.

12a. Previous submission of this proposal. If you have applied to Histiocytosis UK with this proposal please give the reference number and brief reasons for the resubmission.

13. Previous grants from Histiocytosis UK. Please give the reference number(s) of previous grants from Histiocytosis UK and ensure that you are up to date with submission of reports.

14. Terms and Conditions Acceptance Institution/ Host Confirmation and Acceptance of the administration and financial management of
this award IF granted. (Note: Applications WILL NOT be accepted without this confirmation).

Consented by checking this box: -
1. We agree that we have read and understood the Terms and Conditions applicable to any successful application.

4. We agree that we will sign on presentation the TERMS & CONDITIONS as presented to us by Histiocytosis UK.