To be filled by the applicant

Project title

Principle investigator name

Title / position

Institution

Mobile number

E-mail

Project type

Record review Quantitative studies (e.g. Observational study) Qualitative study

Study origin Institutional (SCFHS) National International

Budget requested from SCFHS No Yes Amount SR

Proposed Starting Date / Duration of the study month

Key words

Research Proposal Form

Research team

Name Title Institution Email SCFHS Registration No.

PROJECT INFORMATION

For official use only

Date received

Type of review Expedited

Full-board

Study protocol number

Checklist

1. The proposal• Sections of introduction, specific aim and objectives, methodology, ethical consideration,

budget and work plan are filled incomplete to format .

2. Associated forms and Documents• Copy of questionnaire utilized

• Copy of data collection sheet

• CVs summary of all investigators

• If the study is mutli- center study, a copy of the agreement (contract) and approval of

research regulatory body similar to IRB should be enclosed.

CVs summary for all investigator(s) should be attached to the proposal form on submission.

PROJECT INFORMATION

1. Introduction and Background

This section should provide a brief background to the research proposal, highlighting the importance of the topic, scope of work and conditions in which the project will be executed. Expected results should also be provided as well as an enumeration of fields/areas and the extent of their utilization.

1. Introduction and Background

This section should provide a brief background to the research proposal, highlighting the importance of the topic, scope of work and conditions in which the project will be executed. Expected results should also be provided as well as an enumeration of fields/areas and the extent of their utilization.

2. Literature Review

This section should provide a comprehensive review of the current, relevant literature to both the problem statement and the proposed problem is presented using updated references.

2. Literature Review

This section should provide a comprehensive review of the current, relevant literature to both the problem statement and the proposed problem is presented using updated references.

3. Aim of the study

This section should provide a comprehensive review of the current, relevant literature to both the problem statement and the proposed problem is presented using updated references.

4. Research Question or Hypothesis

5. Study Objectives

This section should provide a brief background to the research proposal, highlighting theimportance of the topic, scope of work and conditions in which the project will be executed.Expected results should also be provided as well as an enumeration of fields/areas and theextent of their utilization.

Describe clearly what you expect to achieve by a project.

• Primary objectives:

• Secondary objectives

6. Research design and method

Discuss IN DETAIL the experimental design and procedures that will be used to accomplish the specific aims of the project. Describe the protocols to be used and provide a tentative sequence or timetable for the investigation. Include the means by which data will be analyzed and interpreted. Describe any new methodology and its advantage(s) over existing methodologies. Discuss potential technical difficulties and/or limitations, limitations in interpretation of the results, and alternative approaches that could be used to achieve the aims. Suggested length: eight pages.

• Setting

• Inclusion and exclusion criteria

• Description of Research design

6. Research design and method

Discuss IN DETAIL the experimental design and procedures that will be used to accomplish the specific aims of the project. Describe the protocols to be used and provide a tentative sequence or timetable for the investigation. Include the means by which data will be analyzed and interpreted. Describe any new methodology and its advantage(s) over existing methodologies. Discuss potential technical difficulties and/or limitations, limitations in interpretation of the results, and alternative approaches that could be used to achieve the aims. Suggested length: eight pages.

• Sample size calculation and sampling technique

• Proposed Statistical analysis Proposed Methods for analysis should be adequately specific and appropriate considering the research question, study design and the scale of measurement

6. Research design and method

• Ethical consideration

- Consent procedure:

-Storage of collected research data :

6. Research design and method

• Ethical consideration

- confidentiality protection for participants:

- Authorship of participants:

Work Plan

Kindly list in details the project tasks, duration and involvement of each member of the project team using the text field below

• Tasks

• Member involved

• Duration

SUMMARY PROPOSED BUDGET SR

Project title

DURATION

Budget request

Is this research funded? No Yes

Is there any budget requested from SCFHS for this project? No Yes

If yes, please fill in the below budget sheet in compliance to the budget instruction at Policy of Good Practice.

ITEM

INVESTIGATORS NAME Role Compensation

INVOLVEMENT

TOTAL DESCRIPTION

MONTHS BUDGET

Principal Investigator 1200/ month

Co-Investigator 1 1000 / month

Co-Investigator 2 1000 / month

Co-Investigator 3 1000 / month

Co-Investigator 4 1000 / month

Phd Students 800 / month

Ms Students 600 / month

Undergraduate Students 400 / month

Technicians 400 / month

Secretarial 1,000 / year

TOTAL SALARIES MAX. 50,000

Budget request

EQUIPMENT & MATERIAL

PC / LAPTOP (Standard) 6,000

WORK STATION / SPECIAL LAPTOP

-

PRINTER (Standard

Laser)1,500

SCANNER (Standard) 500

SOFTWARE -

HARDWARE -

EQUIPMENT -

MATERIALS -

SERVICES -

ITEM TOTAL MAX. 50,000

TRAVEL

INTL. CONFERENCES 10,000 Per Year (Max)

PER DIEM LOCAL -

PER DIEM OVERSEAS -

ITEM TOTAL

OTHERS

PUBLICATIONS 3,800 Per Project (Max)

BOOKS & REFERENCES 2,500 Per Project (Max)

STATIONERY 1,000 Per Year (Max)

ITEM TOTAL

GRAND TOTAL

Budget request

Is this study a multi center study? No Yes

List all references cited in the text, including all authors and the full title of the publication

If yes, please list the centers participating in this study.

Collaboration

References

Principal Investigator Name: Date:

Signature