Sheet 1: Cover Page Grant Application

	
	
	
	
	
	

		

 
		
		
European College of Veterinary Surgeons
		


		


		


		


		


		


		


	
	

		
c/o Vetsuisse Faculty University of Zurich, Equine Department
		


		


		


		


		


		


		


	
	

		
Winterthurerstrasse 260, CH-8057 Zurich, Switzerland
		


		


		


		


		


		


		


	
	

		
Phone:
		
+41 (0)44 635 84 92
		


		


		


		


		


		


	
	

		
Fax:
		
+41 (0)44 635 89 91
		


		


		


		


		


		


	
	

		
email:
		
info@ecvs.org
		
   / www.ecvs.org
		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


	
	

		
RESIDENT RESEARCH GRANT APPLICATION FORM
		


		


	
	

		


		


	
	

		


		


		


		


		


		


		


		


		


		


	
	

		
Yellow fields to be completed by applicant.
		
Gray fields are completed automatically.
		


		


	
	

		


		


		


		


		


		


		


		


		


		


	
	

		
A. Cover Page Grant Application
		


		


		


		


	
	

		
(to be completed by investigator(s))
		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


	
	

		
1. Title of Proposal:
		
This is a sample title
		


		
This title will automatically be transferred to the blinded research proposal section.
	
	

		


		
	

		


		


		


		
	

		


		


		


		
	

		


		


		


		


		


		


		


		


		


		


	
	

		
2. Investigators:
		
Diplomate Supervisor
		


		


	
	

		


		


		
Name, degree
		
Sample Supervisor, DVM
		


		


	
	

		


		


		
Title
		
Prof., Dipl. ECVS
		


		


	
	

		


		


		
Signature
		


		


		
Please insert electronic signature (image) or print, sign physically and scan.
	
	

		


		


		


		
	

		


		


		


		
	

		


		


		
Mailing address
		
City University
Faculty of Veterinary Medicine
University lane 1
1000 University Town
A Country


		


		


	
	

		


		


		
(incl. department, service or laboratory)
		


		


	
	

		


		


		


		


	
	

		


		


		


		


	
	

		


		


		


		


	
	

		


		


		


		


	
	

		


		


		
phone
		
+12 345 678 90
		


		


	
	

		


		


		
email
		
sample.supervisor@mmail.com
		


		


	
	

		


		


		


		


		


		


		


		


		


		


	
	

		


		


		
Resident Applying for Research Grant
		


		


	
	

		


		


		
Name, degree
		
Sample Resident, DVM
		


		


	
	

		


		


		
Title
		


		


		


	
	

		


		


		
Year of residency
		
1st
		


		


	
	

		


		


		
Signature
		

 
		
		


		
Please insert electronic signature (image) or print, sign physically and scan.
	
	

		


		


		


		
	

		


		


		


		
	

		


		


		
Mailing address
		
City University
Faculty of Veterinary Medicine
University lane 1
1000 University Town
A Country


		


		


	
	

		


		


		
(incl. department, service or laboratory)
		


		


	
	

		


		


		


		


	
	

		


		


		


		


	
	

		


		


		


		


	
	

		


		


		


		


	
	

		


		


		
phone
		
+12 345 667 78 89
		


		


	
	

		


		


		
email
		
sample.resident@mail.com
		


		


	
	

		


		


		


		


		


		


		


		


		


		


	
	

		
3. Dates of Project:
		
From:
		
01/01/2021
		
To:
		
23/09/2023
		


		


	
	

		


		


		


		


		


		


		


		


		


		


	
	

		
4. Amount requested:
		
in EUR:
		
€ 5,400
		
Total Project Budget (in EUR):
		
€ 12,300
		


		
Will automatically be transferred into the blinded research proposal section.
	
	

		


		
	

		


		


		


		


		


		


		


		


		


		


	
	

		
5. Location where study will be performed
		
a) Name of the institution to which payment shall be made:
		


		


	
	

		
Above mentioned university
		


		


	
	

		


		


	
	

		
b) Type of organisation:
		


		


	
	

		
X
		
EU government
		


		
non-EU government
		


		
Mark with X as applicable.
	
	

		


		
Private
		


		
Other (specify):
		


		
	

		


		


		


		


		


		


	
	

		


		


		


		


		


	
	

		


		


		


		


		


	
	

		
c) Name, title, and phone number of official(s) signing for the Applicant's institution:
		


		


	
	

		
Sample Supervisor, Prof., Dipl. ECVS, +12 345 678 90
		


		


	
	

		


		


	
	

		


		


	
	

		


		


	
	

		


		


		


		


		


		


		


		


		


		


	
	

		
6. Humane Care and Use of Animals
		
Title of Proposal:
		


		


	
	

		
This is a sample title
		


		
Automatically transferred from above.
	
	

		


		
	

		


		
	

		
Investigators:
		


		


	
	

		
Diplomate Supervisor:
		


		
Sample Supervisor, DVM
		


		
Automatically transferred from above.
	
	

		
Resident
		
Sample Resident, DVM
		


		
	

		
additional investigator(s)
(if applicable)
		
Additional investigator 1
		


		
Please complete if additional investigators are involved in the project.
	
	

		
Additional investigator 2
		


		
	

		


		


		
	

		


		


		


		


		


		


		


		


		


		


	
	

		


		
Pursuant to policy established by the Regents of the European College of Veterinary Surgeons and published in the ECVS training guidelines (Residency Programme Guidelines and Alternate Training Guidelines), I certify that the above described protocol follows the guidelines set forth by the Regents of the European College of Veterinary Surgeons, as published in the ECVS training guidelines, and that the conduct of the study is in compliance with the pertaining laws and regulations of the European Community and the country where the research is conducted. 

Note: Proposals from private practice (Alternate Training Programmes) must seek local/regional ethical approval and must be signed by the supervising Diplomate.
		


		


	
	

		


		


		


		


		


		


		


		


		


		


	
	

		


		
Ethical approval has been requested
(incl. analgesia where appropriate):
		
yes
		


		
Please select applicable values from drop down menu.

Please also sign below if not required.
	
	

		


		
Ethical approval has been obtained:
		
awaiting approval
		


		
	

		


		
Ethical approval is not required:
		


		


		
	

		


		
Institutional ethical approval reference:
		
DEMO12.X345-AB
		


		


	
	

		


		


		


	
	

		


		
Signature
		


		


		
Please insert electronic signature (image) or print, sign physically and scan.
	
	

		


		


		
	

		


		


		
	

		


		
Date received:
		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


	
	

		


		
NOTE: Applications in which information relating to ethical approval is unclear, or incomplete, will be automatically rejected and the authors invited to re-submit (once) with clarification. Applications that do not adequately address analgesia, where appropriate, will be managed in the same way.

This completed form must be sent to the ECVS Office by December 1st for evaluation by the Board of Regents in the following February. Notification of the outcome of the application will be sent by the end of February following the Board of Regents’ deliberations. 
		


		


	
	

		


		


		


		


		


		


		


		


		


		


	
	

		
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