Fund Application - Attendance at a UK Meeting or Conference

Novo Nordisk Ltd is the sole donor to The Novo Nordisk UK Research Foundation (NNUKRF), however, NNUKRF decides and allocates funding independently to fulfil its own independent charitable objectives.

Charity registration number: 1056410.

If you have any queries regarding this application form, please contact NNUKRF on ukresearchfoundation@novonordisk.com or go to www.nnukrf.org.uk/how-to-apply for more details.

Important notes:

Applications will be triaged to ensure compliance with these guidelines.

- Please insert a maximum 1000 word summary of your CV in this application form. The CV should also include relevant publications of the applicant if there are any

- No retrospective awards will be considered (i.e. only meetings occuring after the award date on 31st March 2025 can be considered)

- Applications cannot be accepted without the applicant's manager's approval, please ensure you provide their name and contact details

- Only the first application submitted to us will be accepted

- Incorrectly completed applications will be rejected

- Priority will be given to applicants who will be presenting at the meeting or conference they are seeking support to attend

- For successful applicants this document including the CV will be securely stored until we receive the final report

- For unsuccessful applicants this form and CV will be securely stored for 12 months

- Applications including CVs are shared with the Nurse and Allied Healthcare Professional Selection Committee and may be shared with the Board of Trustees

- Due to the large number of applicants there will be no formal feedback to applicants.

Name of main applicant *

Role or job title *

Place of work (full address) *

Phone number *

Email address *

Preferred contact method *

1. Title of meeting or conference for which support is requested. Please outline key aspects of the meeting/conference programme which will be relevant to your practice and how knowledge attained will translate back to enhanced clinical care for patients with diabetes. *

0/250 words

2. Please provide a link to the meeting/conference *

3. Date of meeting: * +

4. Insert one page agenda or outline for the meeting *

5. Have you submitted or intend to submit an abstract? *

Yes

Not Sure

If yes, what will be the title of your abstract? If yes, what will be the title of your abstract?

6. Amount requested, including breakdown of costs: *

0/250 words

7. Justification of your application (maximum 250 words) i.e. potential benefits to yourself and/or your diabetes service. Please clarify how your attendance at such a meeting will contribute to your learning and development plan, how in turn this will benefit patients with diabetes, or those who may develop the condition: *

0/250 words

8. Have you successfully applied to NNUKRF before? *

Yes

9. If yes, did you submit a final report? *

Yes

No (if no, please state why) No (if no, please state why)

10. Please indicate where you saw the Diabetes Fund advertised? *

Consent:

Should the application be successful we give consent for the named applicant(s), photos/images and award information to be shared on the NNUKRF website and any promotional material and, if required, consent for this information to be included in the NNUKRF Annual Report (which is public domain and published on the Charity Commission website).

We confirm that we have read this application and that if a Diabetes Fund is awarded, the funds will be used for the purposes as stated or will be returned to the Foundation.

We have met internal obligations and can confirm this is a legitimate application. The applicant agrees to submit a short report to NNUKRF after the conference or meeting is over.

Signature of applicant: *

clear

Name: *

Date: *

I have the approval of my manager/Head of Department

Name of applicants manager/Head of Department: *

Email address of applicants manager/Head of Department: *

Contact number of applicants manager/Head of Department: *

Signature of manager/Head of Department:

clear

If signature of manager/Head of Department isn't available, please say why...

Curriculum Vitae (CV): Please insert a summary of your CV on this page: *

0/1000 words

Nurse	Podiatrist
Dietician	Pharmacist
Other (give details) Other (give details)