INTERNAL (UQ RESEARCH & INNOVATION) REVIEW: To initiate UQ R&I internal review, please email this completed and signed Application Certification Form to NHMRC@research.uq.edu.au. Applications are due to UQ R&I for review by 19 May 2025. SUBMISSION OF FINAL APPLICATION: Advice and instructions regarding the final submission of your application to the NHMRC will be forwarded to you and your principal supervisor and alternative contact by the UQ R&I reviewing officer. Your enrolling School / Institute / Centre will also be included on any correspondence. FOR MORE INFORMATION ABOUT THE UQ APPLICATION PROCESS, VISIT THE RO SCHEME WEBSITE.

APPLICANT CONTACT INFORMATION
Applicant Name: Including title, e.g. Dr	Gender:	Choose an item.
Self-Description:
Applicant Email:	Phone:
Principal Advisor Name*:
Principal Advisor Email*:	Phone:
Alternative Contact Name**:
Alternative Contact Email**:	Phone:

*Provision of your principal advisor (PA) contact details is mandatory. Your (PA) will be copied into all key UQ R&I feedback items and updates.

** Alternative contacts will be copied into all RO feedback items and updates.

SUMMARY APPLICATION INFORMATION
Application ID†:
Application Title:
UQ Admin School/Centre:
UQ Admin Faculty/Institute:
Please advise if your application is being (or has been) read by your Principal Advisor:	Yes ☐ No ☐

† This is the ID of your application in Sapphire, e.g., 2046111.

STATISTICAL INFORMATION These data are collected to help the Australian Government understand research being conducted in Australia.
Type of research (must total 100%): Information on the types of research is available from the UQ R&I website. This information is collected for ABS.	Strategic	Experimental	Pure	Applied
%	%	%	%
Fields of Research (FoR) codes (up to 3) FoR codes are available via the UQ R&I website. Please ensure you use 6 digit codes, totalling 100%.	FoR 1	FoR 2	FoR 3
Enter 6-digit FoR	Enter 6-digit FoR	Enter 6-digit FoR
%	%	%
Socio-Economic Objective (SEO) codes (up to 3) SEO codes are available via the UQ R&I website. Please ensure you use 6 digit codes, totalling 100%.	SEO 1	SEO 2	SEO 3
Enter 6-digit SEO	Enter 6-digit SEO	Enter 6-digit SEO
%	%	%

Applicant Checklist – Key action items
Full application complete in Sapphire and UQ Research Office notified.	☐
If Priority Scholarship category: evidence of registration to practise in Australia provided to the UQ Research Office. Not applicable if you are a graduate undertaking a combined MBBS / PhD program.	☐
This Application Certification Form signed/certified (Applicant; Principal Advisor; Head of School/Centre/Institute) emailed to UQ R&I to initiate internal review.	☐
Eligibility requirements have been met and, if required, evidence has been provided to the UQ Research Office.	☐

All certifications must be obtained prior to the submission of the Application to the National Health and Medical Research Council (NHMRC). The University of Queensland (UQ) will retain this form for its records. Certification may be by handwritten signature on this form, or via e-mail provided the e-mail includes the relevant certification statement (below) and the full name, position and contact details of the person certifying. Certifications must be provided by: ● Chief Investigator A (certifying to a Conflict of Interest statement and the provisions of A) and the Principal Advisor (certifying to B), and the head of the UQ host organisational unit (Head of School/Institute/Centre or equivalent) (certifying to C)

CONFLICT OF INTEREST
Do you have a Conflict of Interest*?	Y N If yes, please provide a copy of the UQ Conflict of Interest Management Plan.

*CONFLICT OF INTEREST
Section 29 of the NHMRC Funding Agreement articulates the NHMRC’s approach to, and requirements for declaring, managing and notifying Conflicts of Interest. Under the NHMRC Funding Agreement, Conflict of Interest means the Administering Institution, a Participating Institution or Personnel working on a Research Activity engaging in any activity or obtaining any interest that would interfere with or restrict the Administering Institution, Participating Institution or Specified Personnel performing a Research Activity fairly and independently. While a conflict may relate to financial interests, it can also relate to other private, professional or institutional benefits or advantages that depend on the conduct of the research or its outcomes. A material personal interest is an interest of a type that can give rise to a real or perceived conflict of interest that could affect the ability of the person to discharge their duties or obligations appropriately. If any parties involved in this project (including participants and organisations) have a conflict of interest in relation to any aspect of the Application, the conflict must be declared to UQ prior to submission. If you later identify that there is an actual, perceived or potential Conflict of Interest or that one might arise in relation to an Application, you must inform UQ in writing immediately, as UQ is required to notify the funding agency. For participants external to UQ, the management of the Conflict of Interest should be agreed with the employing organisation, of which UQ will seek confirmation should the application be successful. Applications from UQ investigators must be consistent with the University’s Conflict of Interest Policy and its Responsible Conduct of Research Policy. Where external for-profit partner organisation/s are part of the Application, to help Investigators identify when a conflict of interest is likely to arise, they should consider the following statements: I hold a paid or unpaid fiduciary/governance/management role, such as being a Director, of one or more of the external partners on this grant Application. I am a paid employee, such as a Chief Scientific Officer, of one or more of the external partners on this grant Application. I or a family member/close associate hold shares (equity) in one or more of the external partners on this grant Application that are not publicly traded entities (i.e. listed on the ASX or similar stock exchange). Any of these associations may be incompatible with UQ being able to support the Application.

CERTIFICATION BY APPLICANT
I agree and acknowledge that: All required information has been provided and is complete, current and correct; All eligibility and other Application requirements have been met; All parties identified in the application have agreed, in writing, to its submission; All personnel contributing to the Research Activity have familiarised themselves with the Australian Code for the Responsible Conduct of Research, the National Statement on Ethical Conduct in Human Research, the Australian Code for the Care and use of Animals for Scientific Purposes and other relevant NHMRC policies concerning the conduct of research, and agree to conduct themselves in accordance with those policies; Before the proposed research can commence, all relevant ethical, biosafety and other clearance/s must be obtained and all statutory requirements must be met; As the Chief Investigator, I provide written agreement to be named on the Application, to participate in the manner described in the Application and to the use of my personal information as described in the NHMRC Privacy Policy; As the Chief Investigator, I provide written agreement for the final Application to be certified; The Application will be excluded from consideration if found to be in breach of any requirements in accordance with the NHMRC Grant Guidelines; If the Application is funded, the research will be carried out in strict accordance with the conditions governing NHMRC grants at the time. Conditions may change during the course of the grant; for example, reporting obligations may change. CIA will need to meet new/changed conditions. If the Application is funded, the research may be used for internal NHMRC quality evaluations/reviews; If the Application is funded, grant offers may be withdrawn and action taken over the life of the grant, if eligibility criteria to accept and/or continue holding a grant are not met; and I have prepared this application and will conduct activities under the grant in compliance with UQ policies and procedures. Furthermore, I understand that: the NHMRC Postgraduate Scholarship for PhD candidates is for three years FTE and I confirm that I am aware / will inform myself of the opportunities (if any) for additional funding from within my School/Institute/Centre, in the event my candidature extends beyond this duration. Finally, insofar as I am not already enrolled in the relevant HDR program at UQ, I undertake: to apply for admission as an HDR candidate through The University of Queensland Graduate School no later than 30 September 2025.

Signature of Applicant (Chief Investigator A):	Date:

CERTIFICATION BY UQ PRINCIPAL ADVISOR (PRIMARY SUPERVISOR)
I confirm that: I am eligible to be appointed as a Principal Advisor in accordance with UQ’s Eligibility and Role of Higher Degree by Research Advisors Policy (Section 2, Clause 8); I am registered on the UQ Principal Advisor Registry or, if not, will apply to be registered before 1 January 2026; consistent with the UQ expectations of Principal Advisors, I take primary academic responsibility for the Applicant as an HDR candidate, or will do so once the Applicant is admitted as an HDR candidate at UQ; I understand that the NHMRC Postgraduate Scholarship for PhD candidates is for three years FTE and I confirm that the Applicant has been / will be made aware of the opportunities (if any) for additional funding from within my School/Institute/Centre, in the event the candidature extends beyond this duration; I have reviewed the application to ensure alignment with the chosen scholarship stream; and I have reviewed this application in full and I support its submission to the NHMRC.

Signature of Principal Advisor (Primary Supervisor):	Date:

Name of Principal Advisor (Primary Supervisor):

CERTIFICATION BY UQ HEAD OF SCHOOL/CENTRE/INSTITUTE
I agree that the project can be accommodated within the general facilities in my School/Institute/Centre and that sufficient working and office space is available for the Applicant; I agree to have the project carried out in my School/Institute/Centre as set out in this Application and agree that the research be carried out in strict accordance with the conditions governing NHMRC research grants at the time, including the NHMRC Funding Agreement and NHMRC policy and guidelines; and I confirm that the Applicant, if successful, will be enrolled as an HDR candidate in my School/Institute/Centre for the duration of the grant, subject to meeting the requirements in the University’s Admission Policy and Higher Degree by Research Admission Procedure and being admitted as an HDR candidate at UQ. I understand that the NHMRC Postgraduate Scholarship for PhD candidates is for three years FTE and I confirm that the Applicant has been / will be made aware of the opportunities (if any) for additional funding from within my School/Institute/Centre, in the event the candidature extends beyond this duration.

Signature of Head of School/Centre/Institute:	Date:

Name of Head of School/Centre/Institute: