Guts UK/Dr Falk Dietitian Recognition Prize

Guts UK/Dr Falk 2024 Dietitian Recognition Prize Application Form

Dr Falk Pharma and Guts UK invite applications from gastroenterology (including hepatology and pancreatology) dietitians working in primary or secondary care for a £1,000 prize in recognition of an innovation that has led to an improvement in patient care.

Applications should be completed through the form below. A PDF version of your application will be sent to your email address after you submit the form (check your spam/junk folder if you have not received it and please ensure you use an email account that will allow the delivery of the PDF attachment). Please print this off, obtain all relevant signatures and email a scanned signed full application to research@gutscharity.org.uk by 12 February 2024 at 5pm. The application will only be considered complete once we receive the signed version. Applications received after this time will not be considered.

Please do not exceed the word limits set in the application form and ensure rich text formatted sections use 11 size font.

If there are any issues, please contact research@gutscharity.org.uk

Application Form: * REQUIRED
Tick box to confirm this is the award you want to apply for.
- Guts UK/Dr Falk 2024 Dietitian Recognition Prize
Applicant's name * REQUIRED
Title First Last
Applicant's address for correspondence * REQUIRED
Address Line 1 Address Line 2 City County Postal Code Country
Applicant's email address * REQUIRED
Applicant's phone number * REQUIRED
Applicant's further education/training * REQUIRED
Add in reverse chronological order, most recent first. Include other Honours and Awards. Click on the + button to add more rows.
Institution Degree Class Subject Year of award
Present and previous posts * REQUIRED
Add in reverse chronological order, most recent first.
Start date End date Job title Location
Describe the issue you wanted to address in your project/work * REQUIRED
Maximum 800 words.
Describe what you did to address the issue * REQUIRED
Maximum 800 words.
Describe the impact on patient care/service delivery of your innovation and how this was measured * REQUIRED
Maximum 800 words.
Corresponding figures (optional)
Please use this section to upload any tables or images to support your project. Upload a single file of maximum 2 pages length. Ensure tables and images are referenced clearly in the essay.
Max. file size: 50 MB.
Reference from Manager * REQUIRED
Scan and upload a single file of maximum 1 page length. Please make sure the reference includes the following information:
Signed ……………………………………………………………
Dated ……………………………………............................…
Name................................................................................
[BLOCK CAPITALS]
Job Title............................................................................
[BLOCK CAPITALS]
Max. file size: 50 MB.
Guts UK Standard Release Form * REQUIRED
Tick the box to indicate the applicant's institution accepts and agrees to the Guts UK Standard Release Form terms. As a charity it is best practice for Guts UK to announce the awards it funds on its website.
- In submitting this application, the applicant’s institution accepts and agrees to the terms relating to the Guts UK Standard Release Form set out below:
  
  Summary information about the successful application, including the title of the project, the applicant’s name and institution, the summary of the project, and the value of the award, might be published on Guts UK website and on social media channels, as soon as the award is announced.
Data Protection Information * REQUIRED
Tick the box to indicate that relevant staff at the applicant’s institution have been informed about the data protection information set out below.
- In submitting this application, the applicant’s institution confirms that it has informed relevant staff about the data protection information set out below:
  
  Guts UK may contact applicants, co-applicants and their institutions by email, telephone or post about their applications or other pertinent issues. Personal and other data on applications to grants and other awards will be stored by Guts UK to aid the processing of applications, and for auditing, review and evaluation purposes, and as set out in the Standard Release Form (see above). Information will not be shared with any third party except for aiding those purposes (e.g. data sharing of grant and other awards with the Association of Medical Research Charities). All personal information will be stored and processed in accordance with the Data Protection Act 1998 (and any subsequent legislation and guidance relating to data protection, in particular the General Data Protection Regulation 2016 and the Data Protection Act 2018). Processing of personal data is necessary for the legitimate interests pursued by Guts UK and with other third parties as set out above, and will be limited to that which is proportionate to those interests. Further information as to how Guts UK use and protect your data is available in Guts UK’s Privacy Policy, accessible from https://gutscharity.org.uk/privacy-policy/
Award publicity with Dr Falk
Dr Falk would like to liaise with the successful applicant to publicise the award and the project. Please check the box below to indicate you agree to be contacted by Dr Falk about this.
- I agree to be contacted by Dr Falk with regards to the preparation of relevant publicity materials and support for media coverage of the award and the project.
I wish to apply for the Guts UK/Dr Falk Dietitian Recognition Prize 2024. * REQUIRED
Add your full name in the online form and then sign and date here when preparing the scanned signed version of the application.

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Institution	Degree	Class	Subject	Year of award

Start date	End date	Job title	Location

Guts UK/Dr Falk Dietitian Recognition Prize

Guts UK/Dr Falk 2024 Dietitian Recognition Prize Application Form

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