Y Lab HARP Seed (R&D) EOI Nov 2020

This form is for health and care organisations to express interest in the HARP Seed (R&D) Programme in Wales, 2020. Please complete this form as soon as possible, but no later than 10am on 23 Nov 2020. Your data will be stored in accordance with Nesta's privacy policy: https://www.nesta.org.uk/privacy/

1. Your first name *This question is required.

2. Your last name *This question is required.

3. Your e-mail address *This question is required. This question requires a valid email address.

4. Your telephone number (mobile preferred) *This question is required.

5. Your role title *This question is required.

6. The organisation you are representing in this application *This question is required.

8. Registered charity number (if applicable)

9. Organisation address *This question is required.

Street address *This question is required.

Town / city *This question is required.

Postcode *This question is required.

10. Location of the place you would like us to work with in HARP seed (both geographic location and whether this is, say, a ward, hospital, GP practice, a particular community, the online setting, or a part of your system e.g. comms team) - more than one place is fine, too. *This question is required.

11. Who do you want to benefit in this challenge? (e.g. hospital staff in intensive care units, people with a mental health diagnosis, public health for people experiencing racism) and why (up to 150 words) *This question is required.

14. Can you tell us a little more about the health system challenge you are looking to address and how Covid-19 has affected this? (e.g. access to patients, workforce retention/sickness, underrepresentation of this group in a health service) (up to 200 words) *This question is required.

15. What do you hope to achieve and learn through the Seed programme? (up to 200 words) *This question is required.

16. Who is sponsoring you to take part in this project (this needs to be someone in a leadership role in your organisation) *This question is required.

First Name *This question is required.

Last name *This question is required.

Position / role *This question is required.

E-mail address *This question is required. This question requires a valid email address.

17. Contact for collecting data on impact in your organisation (evaluation manager, researcher, data lead) - ideally this should be a different person from the main contact. *This question is required.

First name *This question is required.

Last name *This question is required.

Position / role *This question is required.

E-mail address *This question is required. This question requires a valid email address.

18. Contact for communications and marketing - ideally this should be a different person from the main contact. *This question is required.

First name *This question is required.

Last name *This question is required.

Position / role *This question is required.

E-mail address *This question is required. This question requires a valid email address.

19. The Seed programme will take part between Dec 2020 and Apr 2021. This will involve desk research, setting up projects, speaking to the Y Lab Programme team and participating in webinars every 1-2 weeks. Are there any extended periods of time during this that you know you will be unavailable for? *This question is required.

20. Is there any other information you'd like to share with us at this time?

Y Lab HARP Seed (R&D) EOI Nov 2020

HARP Seed (R&D) Programme 2020-21 - Health Org Expression of Interest Form