INTERNAL UQ RESEARCH OFFICE REVIEW: To initiate UQ RO review, please email this completed and signed Application Certification Form to NHMRC@research.uq.edu.au. If certifications for Part B and C are incomplete, please email Part A only (UQ Lead CI Certification) to initiate UQ RO internal review. The UQ RO internal closing date for applications is 2 July 2025. SUBMISSION OF FINAL APPLICATION: Advice and instructions regarding the final submission of your application to the NHMRC will be forwarded to you, your mentor and the alternative contact listed below by the UQ RO reviewing officer. FOR MORE INFORMATION ABOUT THE UQ APPLICATION PROCESS, VISIT THE UQ INVESTIGATOR GRANTS WEBSITE.

APPLICANT CONTACT INFORMATION
Applicant Name: Including title, e.g. Dr, A/Prof, Prof
Applicant Email:	Phone:
Alternative Contact Name*:
Alternative Contact Email*:	Phone:

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

APPLICATION SUMMARY INFORMATION
Application ID:
Application Title:
UQ Admin School/Centre:
UQ Admin Faculty/Institute:
Please indicate which RO Review type you would like for your application: N.B. Grantscraft review is full eligibility and compliance, along with suggestions for improvement	Grantscraft review ☐ Eligibility and Compliance only ☐

STATISTICAL INFORMATION
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
%	%	%
For applicants seeking their salary as an NHMRC Emerging Leadership or Leadership Fellow, please provide details of the proposed UQ appointment during the term of the Fellowship, if the Application is successful. NB: The Fellowship term is five years – it would be expected that the Fellow be appointed on a five-year appointment.
Level of Appointment at commencement of the Investigator Grant (e.g., B01):
Additional comments:

Funding Partners: For research proposals that align with NHMRC’s funding partners (Cancer Council QLD, Cerebral Palsy Alliance, MS Australia), applicants can indicate interest in their Investigator Grant being funded by or in conjunction with one of these organisations. *Please discuss with you administering unit before selecting “Yes” in Sapphire. If your application is awarded through a funding partner (not NHMRC) there will be a salary gap requiring coverage by your administering Faculty/Institute/School/Centre. Head of School/Institute Director certification of intent to cover this gap should be provided in the certification (B) below.
Have you answered ‘Yes’ to your application being provided to funding partners in Sapphire?	☐ Yes* ☐ No

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: ● CIA (certifying to a Conflict of Interest statement and the provisions of A) to initiate UQ R&I review of the application, ● The head of the UQ host organisational unit (Head of School/Institute/Centre or equivalent) (certifying to B) prior to submission, and ● Any other organisation contributing to the project (CEO or their delegate) if applicable (certifying to C) prior to submission.

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 will be obtained and all statutory requirements will 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. I understand that as CIA, I 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, the Head of Department of the Administering Institution (and Participating Institution/s, if applicable) will ensure the appropriate facilities will be available. 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.
Applicant Name	Do you have a Conflict of Interest^?	Applicant Signature	Date
Yes ☐ No ☐ If yes, see instructions below^

^ If yes, please provide a copy of the UQ Conflict of Interest Management Plan.

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 any proposed additional staff; 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; If successful, the NHMRC Investigator Grant recipient will hold an appropriate appointment in my School/Institute/Centre from the date of commencement and for the duration of the grant; and I have reviewed the justification for the selected level to ensure alignment with the NHMRC Statement of Expectations. If the applicant has answered ‘yes’ to their application being provided to funding partners in Sapphire and the grant is funded by an organisation other than NHMRC, any salary gap will be covered by the School/Centre/Institute.
Name of Head of School/Centre/Institute	Signature of Head of School/Centre/Institute	Date:

CERTIFICATION BY ORGANISATIONS OTHER THAN UQ CONTRIBUTING TO THE PROJECT
My organisation supports the Application, will contribute the resources outlined in the Application, and will ensure the appropriate facilities will be available if the Application is awarded.
Head of Department or contributing Organisation CEO/Delegate
Organisation/Department	Name	Signature	Date:

Please add rows as necessary.

^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 Research Management Framework 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.