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2018 Partnership Engagement GrantPage 1 of 13

Expression of Interest (for partnership projects commencing in 2019)

Instructions to ApplicantsWelcome to the Heart Foundation's online application form.

We would appreciate any feedback regarding our online application process. Please send your feedback by email to: research@heartfoundation.org.au.

Award DetailsInstructions for completing this application, along with Eligibility and Award Stipulations can be found on our website: www.heartfoundation.org.auor by email: research@heartfoundation.org.au . Please read these instructions carefully before submitting.

All initial questions should be directed to the research office of your institution.

The closing date for application is: Friday 18 May 2018 at 5pm AEST. Late or incomplete applications will not be accepted.

It is recommended that you submit this application to your Research Office by Friday 11 May 2018.

Important InformationBefore submission, you will have an opportunity to review and print the application. Once you submit you will not be able to access or make changes to your application while it is under review by your Research Office. the Research Administration Officer at your Administering Institution will review your application and either endorse it or request changes to the application. If the application is endorsed, it will be submitted to the Heart Foundation - no further action will be required by the applicant.If the Research Administration Officer requires changes to the application, you will be notified via email. The Heart Foundation will reinstate your access to your application to enable you to make changes (allow up to once business day).Once you have made you changes you must resubmit your application to the Administering Institution for final endorsement.The Heart Foundation will not make requests for missing documentation or provide opportunities to amend incorrectly completed applications. Incomplete or incorrect applications will not be forwarded for peer review.

Privacy Statement

Your Personal Information is being collected by the Heart Foundation in order to assess your application for this award. If you are not successful in your application we will retain your application on file indefinitely. If you are successful in your application, then we will use your Personal Information to manage your award. We respect your privacy and embrace the principles contained in the Privacy Act. The Heart Foundation (we, us, our) is the National Heart Foundation of Australia and all associated Australian State and Territory Heart Foundation Divisions, full details of which can be found in our Privacy Notice.

If you do not want to receive further communication from us (other than information that relates to this application and successful award) or if you have any questions about privacy please contact the Research Program at research@heartfoundation.org.au or call (03) 9321 1581. Our APP privacy policy is set out in our Privacy Notice and details how you may complain about privacy issues and how we would deal with that complaint. It also explains how you can access, correct or update information we hold about you. A copy of our Privacy Notice is available at www.heartfoundation.org.au or on request. [HFPS06-140410-F]

Acceptance of Use

By continuing with this application you accept the Heart Foundation Online Grants Management System Terms and Conditions of Use.

Page 2 of 13 - Project Overview

Scientinc Project Title Insert Scientific Title - 300 character maximum

Research Category Insert category the research applies to

Project Synopsis/Outcomes: Using lay

terms, describe the overall aims of the

research and expected cardiovascular

health outcomes. Avoid technical terms.

Your answer should be suitable for

release to media and general

publications.

Insert project brief which will be assessed and added to the Heart

Foundation website (if the project is successful). 2000 character

maximum

Page 3 of 13 - Research Categories - Examples

Biology Blood and Vessels

Condition Fibrosis/Scar

Demographics Babies and Infants

Diagnosis & Assessment ECG (Electrocardiogram)

Risk Factors Mental Health

Treatment Remote Ischaemic Preconditioning (RIPC)

Prevention Preventative Device/Technology

Information Technology Social Media

Categories Selected A maximum of eight categories

Page 4 of 13 -

Scheme Scheme

Details

Main Partnership Scheme Organisation Insert name of the organisation who is initiating the scheme

Scheme Name Insert name of the scheme you will apply for

Scheme/Round Closing Date Insert the scheme's closing date

Expected Funding Commencement Date Insert the expected funding commencement date

Page 5 of 13 - Applicant Information

Applicant Title Insert your title

First Name Insert your first name

Last Name Insert your surname

Email Insert your email address

Landline (include Area Code) Insert your work phone number

Mobile Insert your mobile number

Resident Status Select appropriate response

Citizenship or Residence Evidence Attach PDF of evidence (Passport etc) - 20MB maximum using the following naming convention Name_2018_PEG_Citizenship or Residence Evidence (e.g. Smith_2018_PEG_Citizenship or Residence Evidence)

Gender Select appropriate response

Are you of Aboriginal or Torres

Strait Islander descent?

Select appropriate response

Curriculum Vitae Attach PDF of CV 20MB maximum.

Please name your file using the following convention: Last Name_2018_PEG_Applicant_CV (e.g. Smith_2018_PEG_Applicant_CV)

Page 6 of 13 - Applicant Current Work Information

Position Insert your current employment position title

Employer Insert your current employer

Position Start Date Insert the start date of this position

FTE Insert FTE you are currently working at this organisation

Page 7 of 13 - Administering Institution

Institution Name Select the Institution who will administer this award

Administering Institution Contact Person Details

Title Select the research administering officer's title

First Name Insert the research administering officer's first name

Last Name Insert the research administering officer's surname

Landline (include Area Code) Insert the research administering officer's phone number

Institution Email Address Select the research administering officer's email address

This contact person will undertake a final review of your application prior to submission to the Heart Foundation. Please ensure the privacy statement on the Heart Foundation website is acknowledged by the contact person.

Page 8 of 13 - Other Chief Investigators

Title Insert the Chief Investigator's title

First Name Insert the Chief Investigator's first name

Last Name Insert the Chief Investigator's surname

Role in Project Discuss the Chief Investigator's role in the project - 500 character maximum

Current Position Insert the Chief Investigator's current employment position title

Current Institution Insert the Chief Investigator's current employer

Curriculum Vitae Attach PDF of CV - 2 pages and 20MB maximum

Gender Select appropriate response

Aboriginal or Torres Strait Islander descent

Select appropriate response

Page 9 of 13 - Partner Organisations

Organisation Name Insert name of the partner organisation

Partner Organisation Status Select appropriate response

Organisation Location Select appropriate response

Postcode Insert organisation's postcode

State Select appropriate response

Partner Organisation ABN Insert Partner organisations ABN

Insert this organisations role in the project

Cash Support Requested $ Insert the total amount of cash support requested

Financial Support Status Select appropriate response

In-kind Support Requested $ Insert the total amount of in-kind support requested

In-kind Support Status Select appropriate response

Support Requested From The Heart Foundation

Cash Support Amount $ Insert the total amount of cash support requested

How, and over what duration, will any

financial contribution from the Heart

Foundation be expended?

Insert the how the Heart Foundation contribution will be spent, including a

timeline of expenditure

In-kind Support Requested $ Insert the total amount of in-kind support requested

In-kind Support Status Select appropriate response

Detail any in-kind contribution requested

from the Heart Foundation. If a Heart

Foundation staff member has been

identified as a participant in the

proposed project, please provide details

(and indicate whether the staff member

is aware of the request).

Please provide details related to the in-kind contribution - 2000 character maximum

Funding Requested From The Partnership Project Scheme

Main Partner Organisation

Cash Support Requested $ Insert the total amount of cash support requested

Select appropriate response

Descibe the partner organisation's role in the project

Total Proposed Project Budget (Cash)

Total Proposed Project Cash Amount

Page 10 of 13 - Project Outcomes

Relevance to the Heart Foundation:

How will the proposed project

contribute to the Heart Foundation's

work?

Only research projects with the

potential to improve or promote

cardiovascular health/policy/practice

will be considered.

Discuss how this project will align with the Heart Foundation's strategies and goals.

1000 character maximum

Page 11 of 13 - Research Plan and

Figures Research Plan and Figures

Attach PDF of 20MB Maximum. Please name your file using the following convention: Last Name_2018_PEG_Research Plan and Figures (e.g. Smith_2018_PEG_Research Plan and Figures)

Please provide a detailed Research Plan.The Research Plan is limited to two pages, including a maximum of 20 references and must be completed using Arial 12 point font

Page 12 of 13 - Health Equity

Please describe how your

research will consider (or has

considered) these populations?

Select appropriate response

Please provide details: Insert Information - 1000 character maximum

The Heart Foundation is committed to addressing health inequity and to focusing on people who are disproportionately affected by heart disease: people who are socioeconomically disadvantaged, residents of regional, rural and remote areas, Australians from culturally and linguistically diverse backgrounds, and Aboriginal and Torres Strait Islander peoples.

This question will not form part of the assessment of your application

Page 13 of 13 - Submit For Endorsement

Submit For Endorsement

Following this certification page, you will have the opportunity to review your full application prior to sending to your Research Office. You will be able to go back and make changes if necessary. Once the application is submitted you will not be able to make changes.

By submitting this form, an email notification will be sent to both the Heart Foundation and the Research Office at your Administering Institution. Your Research Office will review the application and either endorse it or return it for amendments. You will receive an email notification advising of the status of this application only when your Research Office has endorsed or returned your application.

If you or the Administering Institution do not receive email notifications, please check your spam folders and email settings.

Certification

I certify that all details provided in this application are correct and that I have read, understood, and have abided by the instructions associated with this application.

I confirm that all applicable parties (including Head of Department, Supervisors, Referees and Other Investigators) have reviewed and approved my application, and I have provided evidence of these approvals and agreements to my Administering Institution's Research Office. I also confirm that all applicable parties have read and understood the privacy statement.

I agree to carry out the project in accordance with the principles of the Australian Code for the Responsible Conduct of Research (2007). I acknowledge that all ethics approvals and clearances necessary to complete my project as outlined in this application will be in place before commencement of the work.

I also acknowledge that all supporting documentation has been provided with this application. I understand that my application will not be eligible for consideration by the Heart Foundation if this application is incomplete or lacking the required documents.

I confirm that I have complied with all instructions and understand that failure to do so may result in the withdrawal of the application from the review process.

By submitting this form, I understand my application will be reviewed by the Research Administration Officer at my Administering Institution for endorsement and final submission to the Heart Foundation.