Innovation Grant Application Form

Consent for storing submitted data *

Yes, I give permission to store and process my data

Name *

Membership number *

Duration of Membership (Years) *

Including Postcode

Address

Include Postcode

Telephone *

Email *

How did you hear about this award?

Title of Project *

The case for support should be 3 pages of A4 and be structured as a mini grant application (see guidance).

List attachments you wish to submit to support this application. *

See guidance notes for the information/support that is required as part of the application.

Attachment 1 *

Attachment 2 *

Your application will also be reviewed by lay members of our Communications and Engagement Committee. Please explain in lay terms how your research or innovation project will ultimately benefit patients or the public. 300 word limit

Attach statement of support from your Head of Department or equivalent *

The statement should include the name, organisation, designation and email address of the supporter.