NIHR RDS West Midlands

RDS for the West Midlands - Initial Interest Template:

Please complete as much of this form as you can - the information you provide will allow us to direct your query towards the appropriate advisor, who will contact you to discuss your enquiry in greater detail. (Fields marked * are required)

Study Chief Investigator details

Title *
Name *
Post held *
Local trust, institution or PCT *
Address *
Email address *
Telephone

Contact details (if other than Chief Investigator)

Where did you hear about the RDS WM?

What support would you like from the RDS WM? *

If you have a research idea or are planning to submit a project proposal for funding, please provide the following information:

Project Title

Please provide a brief description of the project, its aims, and why these are important and timely

Please outline your anticipated research plan and the project methodology

How will patients benefit from your research?

Please give details of patient and public involvement in the project (if any)

Which funding body / stream do you anticipate submitting this proposal to?

What is closing date for full applications to this funding stream?

Co-applicant(s) details

Name	Anticipated role in project

Project support from your institution

Does your project have the support of your local Research Manager / Director?	Yes No
Does your project have the support of your local Clinical Director or equivalent?	Yes No

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