Office Use Only Wesley Medical Research Ref. No. APPLICATION FOR RESEARCH SUPPORT This application form must be completed with reference to the Wesley Medical Research Support Program Guidelines and Frequently Asked Questions (available at Applications must be submitted to: Please direct any inquiries to: Research Theme Theme Leader Contact information Cancer Ms Emma Raymond T: 07 3721 1542 E: eraymond@wesleyresearch.com.au and Women’s Children’s Health Cardiology and Cardiac Surgery Dr Kelley Foster T: 07 3721 1503 E: kfoster@wesleyresearch.com.au Neuroscience Infections and Critical Illness Ms Angela Tapuni T: 07 3721 1545 E: atapuni@wesleyresearch.com.au Surgical and Medical Innovations Rural & Remote Health Dr Tamara Street T: 07 3721 1706 E: tstreet@wesleyresearch.com.au 1. Lead Chief Investigator (CI A) 2. Total support requested in this application $ 3. Short project title (Short descriptive title of no more than 20 words in length). Technical Project title (Descriptive title of no more than 30 words in length). Project summary (No more than 100 words in length and intelligible to a lay reader)
Office Use Only Wesley Medical Research Ref. No. APPLICATION FOR RESEARCH SUPPORT This application form must be completed with reference to the Wesley Medical Research Support Program Guidelines and Frequently Asked Questions (available at Applications must be submitted to: Please direct any inquiries to: Research Theme Theme Leader Contact information Cancer Ms Emma Raymond T: 07 3721 1542 E: eraymond@wesleyresearch.com.au Women’s and Children’s Health Cardiology and Cardiac Surgery Dr Kelley Foster T: 07 3721 1503 E: kfoster@wesleyresearch.com.au Neuroscience Infections and Critical Illness Ms Angela Tapuni T: 07 3721 1545 E: atapuni@wesleyresearch.com.au Surgical and Medical Innovations Rural & Remote Health Dr Tamara Street T: 07 3721 1706 E: tstreet@wesleyresearch.com.au 1. Lead Chief Investigator (CI A) 2. Total support requested in this application $ 3. Short project title (Short descriptive title of no more than 20 words in length). Technical Project title (Descriptive title of no more than 30 words in length). Project summary (No more than 100 words in length and intelligible to a lay reader)