Vernieuwingsimpuls/Innovational Research Incentives Scheme Grant application form 2011 Please refer to Explanatory Notes when completing this form

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1 Registration form (basic details) 1a. Details of applicant Title(s): First name: Initials: Prefix: Surname: Male/female: Address for correspondence (for the period of the Vidi-round): Preference for correspondence in English: yes/no Telephone: Cell phone: Fax: Website (optional): Use of extension clause (see Notes): yes/no (if yes, give reasons and calculation) 1b. Title of research proposal 1c. Summary of research proposal (max. 300 words) 1d. Keywords (max. five keywords) 1e. Host institution (if known) 1f. NWO Division (choose one) Interdivisional* ALW CW EW GW MaGW ZonMw N STW * Elucidation of the interdivisional character of the proposal (only to be filled out if you have chosen to submit your application as interdivisional, words): 1

2 1g. NWO divisional discipline In case you submit to one of the following divisions: Physical sciences (EW), Humanities (GW), or Social/Behavioural sciences (MaGW), please indicate the main NWO divisional discipline code, applicable to your application. For a list of these codes, please follow the division link (see Notes). You can select only one main code. You can indicate a second (additional) discipline code in case your research is multi-disciplinary within the NWO division. Division EW or First discipline code (main code) Description Second discipline code (additional) Description GW or MaGW 1h. NWO Domain (choose one) Alfa-Gamma Beta Life Sciences 2

3 Research proposal 2a. Scientific/Scholarly quality Use a maximum of 4000 words on no more than 8 pages. Include details of: - Overall aim, key objectives, scientific/scholarly background - Originality and/or innovative elements of the topic - Research plan including practical timetable over the grant period - Experimental techniques and/or methodology - Originality and/or innovative elements of the approach - Local, national and international collaboration 2b. Research impact Optional, but when filled out the results of the assessment of the research impact, whether positive or negative, will be taken into account in the overall rating of the application. (max words) - Describe the (possible) contribution of the research results to the solution to a cultural, societal, technological or economical problem. - Describe possible use of the results in the near and/or distant future. - Indicate the expected cultural, societal, technological or economical relevance or impact of the research results. - Identify the target groups/ interested parties. - Indicate the steps you will take to get the research results to the target groups. - What contact and or arrangements you have with users and or target groups. 2c. Number of words used: section 2a (max words) Number of words used: section 2b (max words) 2d. Any other important remarks with regard to this application (max. 50 words) 2e. Literature references 3

4 Cost estimates 3a. Budget Staff costs per calendar year in incl. surcharge Scientific Staff Intensity (fte) Duration (months) Year 1 Year 2 Year 3 Year 4 Applicant Postdoc PhD student Non-scientific staff (NWP) Academic level Intensity (fte) Duration (months) Year 1 Year 2 Year 3 Year 4 Year 5 Year 5 HBO/Bachelorlevel MBO/Foundation Degree-level Non-staff costs in Year 1 Give a description of the non staff cost, as detailed as possible Year 2 Year 3 Year 4 Year 5 3b. Indicate the time (in fte) you will spend on the research 3c. Intended starting date 3d. Have you submitted the same idea elsewhere or have you requested any additional grants for this project either from NWO or from any other institution? yes/no (if yes, see Notes) 4

5 Curriculum vitae 4a. Personal details Title(s), initial(s), first name, surname: Male/female: Date and place of birth: Nationality: Birth country of parents: 4b. Master's ( doctoraal ) University/College of Higher Education: Date (dd/mm/yy): Study/main subject: 4c. Doctorate University/College of Higher Education: Date (dd/mm/yy): Supervisor ( promotor ): Title of thesis: 4d. Current employment Current position Fixed term Permanent Post Doc Assistant professor (UD) Associate professor (UHD) Full professor (HGL) Other, please specify: 4e. Work experience since completing your PhD Specify per appointment: number of fte, tenured term ( vast ) / fixed-term ( tijdelijk ), and supervisory responsibilities (if any). 4f. Man-years of research (see Notes) 4g. Brief summary of research over the last five years (max. 250 words) 4h. International activities 4i. Other academic activities 4j. Scholarships, grants and prizes 5

6 List of publications 5a. Publications - International (refereed) journals Include impact factors of journals. Only compulsory if your proposal is to be submitted to Medical Sciences or Life Sciences. - National (refereed) journals - Books, or contributions to books - Other 5b. Average impact factors for your own field Only compulsory if your proposal is to be submitted to Medical Sciences, otherwise optional: see Notes. 6

7 Statements by the applicant I endorse and follow the Code Openness Animal Experiments (if applicable) (see Notes) I endorse and follow the Code Biosecurity (if applicable) (see Notes) I have completed this form truthfully Name: Place: Date: Please submit the application to NWO in electronic form (PDF format is required!) using the Iris system, which can be accessed via the NWO website ( The only exception to this rule concerns applications within the Medical sciences. The Medical Sciences division uses a similar system called ProjectNet, to which access is provided via the division s own website ( For any technical questions regarding submission, please contact the Iris helpdesk 7

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