Practice to Policy® PBC Awards Application

To ensure you are ready to complete the application process, we have put together an overview of things you need for your submission. Please read the application guide before you start your application. Once you have completed the form, please send it (together with any supporting materials required) to practicetopolicy@interceptpharma.com.

1. Applicant details

  • Applicant details (full name, job title, department, address, country and contact information) 
  • Applicants will also need to provide:
    • Legal proof that they are part of their organisation/institution (e.g. scanned copies of organisation institution ID card, payment slip, official document)
    • A letter of support for the project from their organisation/institution
    • Any letters of support from external stakeholders (where applicable) should also be submitted

2. Organisation details

  • Overview of your organisation/institution (size, objectives, vision)

3. Project details

  • Information regarding your capacity to initiate and implement the project in a timely manner

4. Project objectives and measurements

  • A clear methodology including:
    • Specific, measurable, achievable, realistic and time-sensitive project milestones and action steps required to meet project goals
    • Proposed process for collection and analysis of data
    • Deliverables
    • Demonstration of cost-effectiveness where applicable

5. Funding

  • Clear details of the budget plan and cost estimate (demonstration of cost-effectiveness where applicable). Please refer to the budget checklist for further details

6. Timelines

  • Detailed timelines for funding to be released and the requirements for amounts requested

7. Submission Checklist

  • Final checklist and agreements before you submit

Before you start - have you checked if you are eligible?

 

Please ensure that you have completed all sections of the application form – your application cannot be considered if you have not provided information for each section.

 

An application can be recalled on the condition that it is re-submitted by the application deadline of 8 September 2019. 

 

Should you have any questions about completing this form or need to recall an application, please email the Practice to Policy® Health Awards team at practicetopolicy@interceptpharma.com.