Research Collaboration Request Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Project title or description: Applicant name: *FirstLast email Date of application: Your Position: Research institution: Your telephone number: United States +1United States+1United Kingdom+44Afghanistan+93Albania+355Algeria+213American Samoa+1Andorra+376Angola+244Anguilla+1Antigua & Barbuda+1Argentina+54Armenia+374Aruba+297Ascension Island+247Australia+61Austria+43Azerbaijan+994Bahamas+1Bahrain+973Bangladesh+880Barbados+1Belarus+375Belgium+32Belize+501Benin+229Bermuda+1Bhutan+975Bolivia+591Bosnia & Herzegovina+387Botswana+267Brazil+55British Indian Ocean Territory+246British Virgin Islands+1Brunei+673Bulgaria+359Burkina Faso+226Burundi+257Cambodia+855Cameroon+237Canada+1Cape Verde+238Caribbean Netherlands+599Cayman Islands+1Central African Republic+236Chad+235Chile+56China+86Christmas Island+61Cocos (Keeling) Islands+61Colombia+57Comoros+269Congo - Brazzaville+242Congo - Kinshasa+243Cook Islands+682Costa Rica+506Croatia+385Cuba+53Curaçao+599Cyprus+357Czechia+420Côte d’Ivoire+225Denmark+45Djibouti+253Dominica+1Dominican Republic+1Ecuador+593Egypt+20El Salvador+503Equatorial Guinea+240Eritrea+291Estonia+372Eswatini+268Ethiopia+251Falkland Islands+500Faroe Islands+298Fiji+679Finland+358France+33French Guiana+594French Polynesia+689Gabon+241Gambia+220Georgia+995Germany+49Ghana+233Gibraltar+350Greece+30Greenland+299Grenada+1Guadeloupe+590Guam+1Guatemala+502Guernsey+44Guinea+224Guinea-Bissau+245Guyana+592Haiti+509Honduras+504Hong Kong SAR China+852Hungary+36Iceland+354India+91Indonesia+62Iran+98Iraq+964Ireland+353Isle of Man+44Israel+972Italy+39Jamaica+1Japan+81Jersey+44Jordan+962Kazakhstan+7Kenya+254Kiribati+686Kosovo+383Kuwait+965Kyrgyzstan+996Laos+856Latvia+371Lebanon+961Lesotho+266Liberia+231Libya+218Liechtenstein+423Lithuania+370Luxembourg+352Macao SAR China+853Madagascar+261Malawi+265Malaysia+60Maldives+960Mali+223Malta+356Marshall Islands+692Martinique+596Mauritania+222Mauritius+230Mayotte+262Mexico+52Micronesia+691Moldova+373Monaco+377Mongolia+976Montenegro+382Montserrat+1Morocco+212Mozambique+258Myanmar (Burma)+95Namibia+264Nauru+674Nepal+977Netherlands+31New Caledonia+687New Zealand+64Nicaragua+505Niger+227Nigeria+234Niue+683Norfolk Island+672North Korea+850North Macedonia+389Northern Mariana Islands+1Norway+47Oman+968Pakistan+92Palau+680Palestinian Territories+970Panama+507Papua New Guinea+675Paraguay+595Peru+51Philippines+63Poland+48Portugal+351Puerto Rico+1Qatar+974Romania+40Russia+7Rwanda+250Réunion+262Samoa+685San Marino+378Saudi Arabia+966Senegal+221Serbia+381Seychelles+248Sierra Leone+232Singapore+65Sint Maarten+1Slovakia+421Slovenia+386Solomon Islands+677Somalia+252South Africa+27South Korea+82South Sudan+211Spain+34Sri Lanka+94St. Barthélemy+590St. Helena+290St. Kitts & Nevis+1St. Lucia+1St. Martin+590St. Pierre & Miquelon+508St. Vincent & Grenadines+1Sudan+249Suriname+597Svalbard & Jan Mayen+47Sweden+46Switzerland+41Syria+963São Tomé & Príncipe+239Taiwan+886Tajikistan+992Tanzania+255Thailand+66Timor-Leste+670Togo+228Tokelau+690Tonga+676Trinidad & Tobago+1Tunisia+216Turkey+90Turkmenistan+993Turks & Caicos Islands+1Tuvalu+688U.S. Virgin Islands+1Uganda+256Ukraine+380United Arab Emirates+971United Kingdom+44United States+1Uruguay+598Uzbekistan+998Vanuatu+678Vatican City+39Venezuela+58Vietnam+84Wallis & Futuna+681Western Sahara+212Yemen+967Zambia+260Zimbabwe+263Åland Islands+358Your email address: * Additional researchers and their institutions: Name, address and contact details of head of department, centre or unit where research is to be undertaken: Grant opportunity or proposed funding source Name of funding organisation: Funding application due date: Name of specific grant opportunity: Lay language description of project and purpose (less than 100 words): 0 of 100 max words.What support are you requesting from HeartKids? (for example, grant support letter, in-kind donation of staff time, assistance in recruitment for the study, etc.) Please attach project summary or draft grant application. Click or drag a file to this area to upload. Submit
