UCL Institute of Mental Health
              Application for Public Engagement Grants 
              2022/23 Academic Year
                                                                                        th 
              The application must be completed and submitted electronically by 1 pm on 27 September
              2022  to the Institute of Mental Health Research Coordinator, Ana Antunes-Martins
              (a.antunes-martins@ucl.ac.uk).
              Each application must include this application form, the budget form, and the CV of the first
              applicant.  Please combine all documents into a single pdf document.
              Please note that signatures are required from the first UCL applicant, as well as the first
              applicant’s Head of Department. Electronic signatures are acceptable. 
              If you have any questions about the scheme, or about completing the form, please contact
              the IoMH Research Coordinator, Ana Antunes-Martins (a.antunes-martins@ucl.ac.uk).
              Project Team
              UCL applicants 
              First applicant 
              This must be a UCL staff member whose contract outlasts the end date of the proposed 
              activities.  
              Contact details
              Title
              First name
              Last name
              UCL Department 
              UCL Division or Institute
              Current post 
              Post duration
              Correspondence address
              Telephone number(s)
              Email address
              Relevant Experience in Public Engagement or Research Co-Production Activities 
                    Activity            Source of        Date                Brief details
                                        Funding
                Please include a brief CV of the first applicant. 
                Second applicant (optional) 
                Second applicants may be UCL staff members or students 
                Contact details
                Title
                First name
                Last name
                UCL Department 
                UCL Division or Institute
                Current post 
                Post duration
                Correspondence address
                Telephone number(s)
                Email address
                Relevant Experience in Public Engagement or Research Co-Production Activities 
                       Activity             Source of           Date                  Brief details
                                             Funding
                (Add more applicants if appropriate)
                External partners
                Members of the Public
                ‘Members of the public’ may be community groups or individuals, including those with lived 
                experience of mental health disorders, service user representatives, or members of the 
                general public.
                Title
                First name
                Last name
                Organisation/Company 
                Correspondence address
                Telephone number(s)
                Email address
                Relevant Experience in Public Engagement or Research Co-Production Activities
                       Activity             Source of           Date                  Brief details
                                             Funding
                (Add more partners if applicable)
                Other External partners (optional)
                Other external partners may include the NHS, local authorities, charities, commercial
                organisations, or policy-making bodies.
                Title
                First name
                Last name
                Organisation 
                Correspondence address
                Telephone number(s)
                Email address
                Relevant Experience in Public Engagement or Research Co-Production Activities
                       Activity             Source of           Date                  Brief details
                                             Funding
       (Add more partners if applicable)
       Proposal
       Please indicate the title of the proposed activity or activities
       Please provide a brief description of the activity/activities to be 
       carried out, in language that would be understood by a non-
       academic audience (maximum 300 words).
       Please state: (a) aims and objectives; (b) specific deliverables and
       their timelines and how these will be planned and developed; (c) 
       expected outputs (maximum 1000 words). 
       Please state the specific contribution of which of the members of 
       the Team