Applicant Details

Name of principal applicant

Position/Role

Organisation/Institution

Your email

Phone number

Address

Project Details

Project title
Clear, concise title (max 20 words)

Summary of proposed project (max 200 words)
Please provide a brief description of what you aim to do, why, and the expected outcomes. Please also provide a short lay summary of the project.

Alignment with the charity’s purpose (max 150 words)
Explain how your project supports the aims of the charity and benefits the relevant patient or beneficiary group.

Detailed project description (500 words)
Please include headings of rationale, objectives, methods, and expected outcomes.

Start date

End date

Key milestones
Month 1, Month 3, Month 6, Final report (Adjust as appropriate)

Budget Summary
Please list each item, with a cost and justification. Only list what you intend to use during the grant period.

Total requested (£)

Is this project funded or supported by any other organisation?
NoYes

If yes, provide details:

Ethical and Regulatory Requirements

(Only if applicable)

Does this project require any of the following?

Ethical approval
NoYes

Institutional permission
NoYes

Data protection/GDPR compliance steps
NoYes

If yes to any, please give a brief explanation:

Applicant Expertise

Please provide a brief CV-style outline (max 150 words) of your relevant experience, any previous work in this area and key team members (if any).

Conflicts of Interest Declaration

Does the applicant, institution, or collaborators have any connection with the charity, trustees, or reviewers?
NoYes

If yes, please describe: