Step 1 of 3 – Project details 33% Name(Required)Email address(Required)An email address we can get back to you on Telephone (Optional)A telephone number we can contact you onYour CV(Required) Drop files here or Select files Accepted file types: pdf, docx, doc, Max. file size: 50 MB. Brief description of your career level and aspirations(Required)Brief description of the home institution supporting you as the applicant and of the nature of support provided to aid you to become an opinion leader in the field of CLL(Required)Evidence of strong mentorship by a senior clinician or scientist from a centre of excellence(Required)Are you a research project or registry?(Required) Yes No Justification for choosing this specific centre of excellence(Required)Are you a visiting training fellowship?(Required) Yes No Approach to data sharing and confidentiality(Required)Ethical implications(Required) Project title(Required)Brief description of the project and predicted impact(Required)Key project goals and objectives(Required)Evidence gap and how the proposed intervention would fill that gap(Required)Full description of the project(Required)“Please include the following: – Background – Scientific rationale (where applicable) – Methods – Utility – Applicability – Affordability and feasibility” Proposed impact of the project on(Required)“Please include the following: – Patients with CLL and their families – The local healthcare facility and research organisation – The healthcare system – The wider clinical and research community of CLL and beyond” Criteria for its evaluation that will define progression to the next stage of development(Required)Project timeline including measurable milestones and outputs(Required)Demonstration of a pathway to further develop the intervention and longer-term sustainability plan(Required)Opportunities for Patient and Public Involvement(Required)Proposed cost breakdown of the project(Required)Justification of costs(Required) Consent(Required) I confirm I have read, understood and agree to the privacy policy.
