FORMAT FOR SUBMISSION OF RESEARCH PROPOSAL...

MISSION INNOVATION (MI) – INDIA

FUNDING OPPORTUNITY ANNOUNCEMENT (FOA): SMART GRIDS

Note: The proposal under the above programme is at 2ND STAGE OF SUBMISSION. The Lead Principal Investigator whose Notification of Intent (NOI) form has been accepted for the next level are only eligible to submit the detailed proposal. DST has already intimated the file number. Kindly quote the File number as it is mandatory.

INSTRUCTIONS FOR FILLING ONLINE APPLICATION

1. Log on http://onlinedst.gov.in/ to access the home page of the “DST e-PMS Portal”.2. To save your time and avoid data loss please download the appropriate proposal format as

suitable for the scheme, fill all the information required as per the given format in a Word and PDF file (max. size 5 Mb) and then keep it ready for upload during submission of mandatory documents.

3. Click on “Submit proposals” link which would take you to a page seeking multiple information starting with – General Information, Principal Investigator etc. Fill all the mandatory information sought against each menu.

4. After filling in all the above particulars there is a provision for preview of details before final submission of the application form by clicking on the “Preview” button. The Preview page will display all the details that you have entered. After verification of the details on the preview page then click on “Submit” button to finally push the data into server.

5. Candidates are hereby advised to carefully fill in and verify the details in the online application as no change will be possible/ entertained after clicking the FINAL SUBMIT BUTTON.

PLEASE NOTE

1 IT IS MANDATORY TO SUBMIT THE PROPOSAL THROUGH THE ONLINE MODE . PROPOSAL SUBMITTED OFFLINE ONLY THROUGH HARD COPY WITHOUT ONLINE SUBMISSION WOULD BE REJECTED AND WOULD NOT BE CONSIDERED FOR ANY FURTHER PROCESSING.

2 CANDIDATES ARE REQUIRED TO SUBMIT A SOFT COPY ALONG WITH TWO HARD COPIES AS PRINT OUT OF THEIR ONLINE SUBMITTED APPLICATION TO THE DST WITH THE SIGNATURES AND RUBBER STAMPS OF THE CONCERNED PERSONS/ OFFICIALS.

3 INCOMPLETE OR WRONGLY FILLED UP APPLICATION FORMAT OR APPLICATION WITH LACK OF ESSENTIAL DOCUMENTS WILL BE REJECTED. ANY LEGAL PROCEEDINGS IN RESPECT TO ANY MATTER OF CLAIM OR DISPUTE ARISING OUT OF THIS ADVERTISEMENT AND / OR APPLICATION CAN BE LODGED ONLY IN DELHI COURTS/ TRIBUNALS/ FORUMS AND ALSO DELHI COURTS / TRIBUNAL/ FORUMS ONLY SHALL HAVE THE SOLE AND EXCLUSIVE JURISDICTION TO TRY ANY CASE / DISPUTE.

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http://onlinedst.gov.in/

4 PROPOSAL SUBMITTED THROUGH E-MAIL WILL NOT BE ENTERTAINED. SUBMISSION OF PROPOSAL OTHER THAN THE PRESCRIBED FORMAT SHALL BE REJECTED WITHOUT ANY FURTHER PROCESSING AS PER PROGRAM NORMS .

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FORMAT FOR SUBMISSION OF PROPOSAL FOR SUPPORT

Mission Innovation Challenge: Smart Grids

CONTENTS

S. No ITEMS Page No(s)I Proposal Summary

II Core Proposal

III Budget

IV Bio-Data of PI and Co-PI

V Undertaking from the Investigator

VI Endorsement from The Head of Institution

VII Endorsement from the Collaborator(s)

VIII Conflict of Interest

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I. Proposal Summary (To be limited to two A-4 sheets)

(MI:SG-2017)DST File No (Mandatory):

1. Project Title2. Project cost

(Amount in lakhs)Total: DST: Collaborator(s) (if any):

3. Duration (in months)4. PI Name

Date of Birth Lead PI

5. Co-PI (s) NameDate of Birth

Co-PI from Lead Organization

6. Lead Organisation7. Status of Lead

OrganisationRecognized universities and academic institutions/ National Laboratories/R&D institution,/Research organizations recognized by DSIR/Companies registered under The Indian Company’s Act, 1956 / MSMEs / Others-Specify the affiliation clearly

8. Partnering Organisation (Academic Institutions), if any

(Consortium may be formed wherever necessary. In sections 11 and 12 of the proposal, clearly explain the need for forming the consortium and the roles and responsibilities of each partner).

9. Details of Partnering Organisations (Academic Institutions)

Please specify the Details of partnering organisation with Name and addresses.

10. Industry Collaborators Please specify the Industry Name

11. Industry Collaborator Details

Please specify the Details of collaborators with Name and addresses.

12. MI Country Collaborator

Please provide the MI Country Name

13. Details of MI Collaborator with Name and Institute Address

Please specify the details of MI country collaborators with Name and addresses.

14. Indian Centric Objectives

(Precise and quantified)

15. MI Country Centric Objectives

(Precise and quantified)

16. Methodology (Highlight the novelty and unique aspects of the proposal )17. Deliverables (Select

the appropriate option(s) and summarise it in single line.)

New/Upgraded Product; New/ Upscaled Process; New/ Upgraded System; Services (including software); Performance analysis; (Scientific data generation; analysis and evaluation); Feasibility analysis; Technological Capability; Database development and documentation; Proof of new concepts at a device level; Achieving State of art performance in a chosen device) (Deliverables should include target performance and projected cost when commercialized for national and international scenarios)

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13. Budget details:A. Project Manpower

(Post & Nos Research group/ institution-wise if more than one institutions are involved)

DST:(JRF/SRF/Research Associate/ Project Assistant / other Professional Manpower)

Collaborator(s):

B. List of Equipmentrequired (Research group/ institution-wise if more than one institutions are involved)

DST: Collaborator(s):

C. Fabricated system /prototype, if any

DST: Collaborator(s):

D Nature of Contribution from Collaborators

In Cash & Kind (Please elaborate)

14. Funds requirements from DST:

S. No Item Head 1st Year 2nd Year 3rd Year Total (Rs.)A Non-recurring (Capital Items)

1 Permanent EquipmentSubtotal (capital items)

B Recurring Items (General)

1. Manpower 2. Consumables 3. Contingencies 4. Travel (Domestic)5. Travel (International)6. Plant cost /Fabricated systems/

Demonstration models7. Other Costs ( Outsource work

etc.),if any8. Overhead

Subtotal (General)C Total cost of the project (A+B)

Total requirement of funds from DST =Contribution of participating institution(s), if any=

Total project cost =

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II. CORE PROPOSAL (Kindly ensure to read the Guidelines (in italics fonts) and fill the text accordingly)

1. Project Title

2. Lead Organization Principal Investigator (PI)*

Name:

Designation:

Complete Address (with city pin code):

Telephone & Mobile No.:

E-mail:

Lead Organization Co-Principal Investigator(s) (Co-PI)

Name:

Designation:

Complete Address (with city pin code):

Telephone & Mobile No. :

E-mail:

3. Indian consortium partner organization(s) / collaborator(s):

Name(s) of Principal Investigator(s)*:

Designation:

Complete address (with city pin code):

Telephone & Mobile No. :

E-mail:(* No project shall be considered in absence of Co- PIs )

(* One Principal Coordinating Investigator has to be identified in case of Consortium Projects)

4. MI Country consortium partner organization(s) / collaborator(s):

Name(s) of Principal Investigator(s)*:

Designation:

Complete address (with city pin code):

Telephone & Mobile No.:

E-mail:

5. Collaborating Agencies/Industries (If any) (Consortia may be formed wherever necessary. The sections 11 and 12 of the proposal, clearly explain the need for forming the consortia and the roles and responsibilities of each partner.)

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6. Target Beneficiaries

7. Objectives of the Proposal (Precise and quantified: Estimated possible values, Use bullet points )

8. Critical Review of Status by Identifying Current Challenges and Gaps ( include important references & IPR survey) 8.1 National Status Review 8.2 International Status Review 9. Novelty / uniqueness of the Proposal ( not more than 50 words ) 10. Outline of the Project (Define the problem and give technical details including schematics wherever necessary) 11. Deliverables of the project ( select the relevant option and give its brief details .(Deliverables should include target performance and projected cost when commercialized for national and international scenarios))

i) New/Upgraded Product: ii) New/Upscaled Process:iii) New/ Upgraded System: iv) Services (including software):v) Performance analysis:

(Scientific data generation, analysis and evaluation)

vi) Feasibility analysis:vii) Technological Capability:viii)

Database development and documentation:

ix) Proof of new concepts at a device level.

x) Achieving State of art performance in a chosen device/system

12. Methodology (This section should also include preliminary/review work done by all the investigators, which is relevant to the project. The description of methodology should adequately demonstrate the pathways, main work elements and highlight the capability of the investigators to achieve them)

13. Work Plan (mention project activities and targeted milestones)

Sl no.

Activity/Milestone

1st year 2nd year 3rd year1-6 M 6-12 M 13-18 M 19-24 M 25-30 M 31-36 M

A1A2-** Draft completion

report for review ( 3 month prior to date of completion )

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14. Names of 5 Experts/Agencies/ Institutions working in the similar area (Please give complete Name, Designation, Email, Address with pin code, telephone number)

15. Any other information relevant to the Project proposal/ execution of the project (Importance of the proposed R & D to India, exceptional strengths of the core group, project site details,

economic viability and feasibility, Institutional Details etc. In case the collaborator is a private sector company, please indicate their plan of commercialization of the product/process/technology development under the project)

16. Facilities & Infrastructure already available to the PI(s) at their Institute for Implementing the project.

S.no

Equipment Name / Funding Source For which purpose it would be utilised in current project

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Budget SummaryDepartment of Science and Technology

Project Title:

File No.:

Principal Investigator:

Collaborative Institute:

Collaborative Industry:

Proposed cost:

Duration:

Non-Recurring budget:

Permanent Equipments: Lead Institute: List of Equipment. Amount required for this Institute

Collaborative Institute: List of Equipment. Amount required for this Institute

The total amount required for the Institutes.

Recurring budget:

1. Manpower: Lead Institute:Manpower Details. Amount required for this Institute

Collaborative Institute:Manpower Details. Amount required for this Institute

The total amount required for both Institutes.

2. Consumables: Lead Institute: List of consumables required. Amount required for this Institute

Collaborative Institute: List of consumables required. Amount required for this Institute


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3. Contingencies: Justification for the resource.

Lead Institute: Amount required for this Institute. Collaborative Institute: Amount required for this Institute.

The total amount required.

4. Travel (Domestic): Justification for travel.

Lead Institute: Amount required for this Institute. Collaborative Institute: Amount required for this Institute.


5. Travel (International): Justification for travel.

Lead Institute: Amount required for this Institute. Collaborative Institute: Amount required for this Institute.The total amount required for both Institutes.

6. Fabrication Cost:

Lead Institute:Details of fabrication with justification. Amount required for this Institute.

Collaborative Institute: Details of fabrication with justification. Amount required for this Institute.

The total amount required for both Institutes.7. Other Cost:

Lead Institute:Details of fabrication with justification. Amount required for this Institute.

Collaborative Institute: Details of fabrication with justification. Amount required for this Institute.


8. Overheads:

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9. Total Budget for all institutes:

Sl. No. Sanction head

A Non-recurring (Capital Items)

I Pmt Equipment Rs.0.00 Rs.0.00 Rs.0 Rs.0.00

Total (Capital) Rs.0.00 Rs.0.00 Rs.0 Rs.0.00


I Man Power Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

II Consumables Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

III Contingency Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

IV Travel (Domestic) Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

V Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

VI Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

VI Other Cost Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

VII Over Heads Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

Total(General) Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

C Grand Total Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

1st Year (Lakh) 2nd Year (Lakh)

3rd year (Lakh) Total (Lakh)

Travel (International)

Plant Cost / Fabrication systems / Demonstaration Models

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The break-up of the cost head wise, year wise and Institute wise.A. The total break-up of the cost head wise and year wise for Lead Institute:




Equipment Details




Manpower Details



V Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

IV Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

VI Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

VI Other cost Details Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00





Travel (Domestic)



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B. The total break-up of the cost head wise and year wise for Collaborative Institute




Equipment Details




Manpower Details



IV Travel (Domestic) Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

V Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

VI Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00

VI Other cost Details Rs.0.00 Rs.0.00 Rs.0.00 Rs.0.00







Note: If there is more than one collaborative institute kindly provide the total break-up of the cost head wise and year wise separately for each.

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IV. Proforma for Bio-Data of Principal Investigator(s) (PI), Co- Principal Investigator(s) (Co PI) and Coordinating Investigator

of each partner Institution (Please be brief and follow the format)

1. Name

2. Gender

3. Date of Birth

4. E-mail ID

5. Qualifications

S. No. Degree Institution Year Division/Class

6. Employment Experience

S. No. Position & Organisation Nature of Job Period

7. Selected List of Ten Best Publications (relevant to the proposed project)

8. Patents filed/Granted with details (relevant to the proposed project)

9. Books Published /Chapters contributed (relevant to the proposed project)

10. Sponsored Research Projects (last five years)

S. No

Title Sponsoring Agency and Officer Concerned

Period Amount Achievements

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a. Consultancy Projects (last five years)

S. No

Title Sponsoring Agency Period Amount

b. Sponsored Research/Consultancy Projects submitted for approval

S.No.

Title Funding Agency

Duration Amount

11. Awards and Honours: A. National list B. International list:

12 Technologies Developed / Transferred: (please provide details of technologies transferred to industry, technologies commercialized)

Date (Signature of PI)

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V. UNDERTAKING FROM THE INVESTIGATOR(S) Project Title:

1. I/We have carefully read the terms and conditions of the MI:SG Programme and I/We agree to abide by them.

2. I/We have not submitted this or a similar Project proposal elsewhere for financial support.

3. I/We have explored and ensured that the equipment and the basic facilities described in the Research Proposal, will actually be available as and when required for the purpose of the Project. I/We shall not request financial support under this project, for procurement of these items.

4. I/We undertake that spare or idle capacity of the permanent equipment procured under the project will be made available to other legitimate users from parent and other organizations.

5. I/We have enclosed the following :

A Endorsement from the Heads of the Institution(on letter head)

B Undertaking from the Collaborator(s)(on letter head)

C Complete Project Proposal with all enclosures (1 marked’ original’ + 2 hard copies + 1 soft copy as .doc file)

Name(s) and Signature(s) of the Investigators*DatePlace

(* To be signed by PI and Co-PI of each Participating Institution)

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VI. ENDORSEMENT FROM THE HEAD OF THE ORGANISATION(To be typed on the letter-head of the organization)

(To be provided by each of the participating Institutions)

Project Title

1. Certified that the organization welcomes the participation of Dr/Mr/Mrs ………………..as the PI and Dr/Mr/Mrs………………as the Co-PI for the project and that in the unforeseen and legitimate event of discontinuation by the PI, the Co-PI will assume full responsibility for completion of the project. Information to this effect, endorsed by me, will be promptly sent to the DST

2. Certified that the equipment, other basic facilities and other administrative facilities as per the terms and conditions of the award of the Project, will be extended to the investigator(s) throughout the duration of the project

3. The Organization shall ensure that financial and purchase procedures are followed as per the prevailing norms of the organization, within the allocated budget.

4. The Organisation shall provide timely the Statement of Expenditure and the Utilisation Certificate of the grant as required by the DST in the prescribed format.

5. The grant for the proposal, if approved , the funds shall be transferred to following organization account :

1 Name of A/c holder (as per Bank record )

2 Bank Account No. 3 Bank Branch Name & Address4 MICR Code5 IFSC Code6 E-mail (Agency /PI )7 Mobile No. (Agency/PI )8 Unique agency code*

* Refer website : http://website.informer.com/visit?domain=cpsms.nic.in

(Head of the Institute)Seal/Stamp

DatePlace

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VII. Endorsement from collaborating Industry/ Agency (if any)(On the official letter head)

I have gone through the Project proposal entitled………….. submitted by ……………(Name of PI) …of…………….(Name of the Institute) for DST funding and noted the obligations and responsibilities indicated in our name which are as below :

1. Contribution in financial terms (mention amount in Rs.)

2. Contribution in kind (list activities)

I hereby affirm that my organization/ industry is committed to participate in the Project to the full extent as indicated including financial liabilities accruing therefrom as detailed above. A brief profile of my organization is summarised below:

Name of OrganisationLine of Business/ Major ProductsNo. of employeesAnnual Turn over

The Annual Report for the last financial year is enclosed.

(Head of the Organisation)Seal/Stamp

DatePlace

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Annexure- IDEPARTMENT OF SCIENCE AND TECHNOLOGY

POLICY ON CONFLICT OF INTEREST

FOR REVIEWER & COMMITTEE MEMBER or APPLICANT or DST OFFICER ASSOCIATED/ DEALING WITH THE SCHEME/

PROGRAM OF DST

Issues of Conflicts of Interest and ethics in scientific research and research management have assumed greater prominence, given the larger share of Government funding in the country's R & D scenario. The following policy pertaining to general aspects of Conflicts of Interest and code of ethics, are objective measures that is intended to protect the integrity of the decision making processes and minimize biasness. The policy aims to sustain transparency, increase accountability in funding mechanisms and provide assurance to the general public that processes followed in award of grants are fair and non-discriminatory. The Policy aims to avoid all forms of bias by following a system that is fair, transparent and free from all influence/ unprejudiced dealings, prior to, during and subsequent to the currency of the programme to be entered into with a view to enable public to abstain from bribing or any corrupt practice in order to secure the award by providing assurance to them that their competitors will also refrain from bribing and other corrupt practice and the decision makers will commit to prevent corruption, in any form, by their officials by following transparent procedures. This will also ensure a global acceptance of the decision making process adopted by DST.

Definition of Conflict of Interest:

Conflict of Interest means "any interest which could significantly prejudice an individual's objectivity in the decision making process, thereby creating an unfair competitive advantage for the individual or to the organization which he/she represents". The Conflict of Interest also encompasses situations where an individual, in contravention to the accepted norms and ethics, could exploit his/her obligatory duties for personal benefits.

1. Coverage of the Policy :

a) The provisions of the policy shall be followed by persons applying for and receiving funding from DST, Reviewers of the proposal and Members of Expert Committees and Programme Advisory Committees. The provisions of the policy will also be applicable on all individuals including Officers of DST connected directly or indirectly or through intermediaries and Committees involved in evaluation of proposals and subsequent decision making process.

b) This policy aims to minimize aspects that may constitute actual Conflict of Interests, apparent Conflict of Interests and potential Conflict of Interests in the funding mechanisms that are presently being operated by DST. The policy also aims to cover, although not limited to, Conflict of interests that are Financial (gains from the outcomes of the proposal or award), Personal (association of relative / Family members) and

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Institutional (Colleagues, Collaborators, Employer, persons associated in a professional career of an individual such as Ph.D. supervisor etc.)

2. Specifications as to what constitutes Conflict of Interest .

Any of the following specifications (non-exhaustive list) imply Conflict of Interest if,

(i) Due to any reason by which the Reviewer/Committee Member cannot deliver fair and objective assessment of the proposal.

(ii) The applicant is a directly relative# or family member (including but not limited to spouse, child, sibling, parent) or personal friend of the individual involved in the decision making process or alternatively, if any relative of an Officer directly involved in any decision making process / has influenced interest/ stake in the applicant’s form etc..

(iii) The applicant for the grant/award is an employee or employer of an individual involved in the process as a Reviewer or Committee Member; or if the applicant to the grant/award has had an employer-employee relationship in the past three years with that individual.

(iv) The applicant to the grant/award belongs to the same Department as that of the Reviewer/Committee Member.

(v) The Reviewer/Committee Member is a Head of an Organization from where the applicant is employed.

(vi) The Reviewer /Committee Member is or was, associated in the professional career of the applicant (such as Ph.D. supervisor, Mentor, present Collaborator etc.)

(vii) The Reviewer/Committee Member is involved in the preparation of the research proposal submitted by the applicant.

(viii) The applicant has joint research publications with the Reviewer/Committee Member in the last three years.

(ix) The applicant/Reviewer/Committee Member, in contravention to the accepted norms and ethics followed in scientific research has a direct/indirect financial interest in the outcomes of the proposal.

(x) The Reviewer/Committee Member stands to gain personally should the submitted proposal be accepted or rejected.

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# The Term “Relative” for this purpose would be referred in section 6 of Companies Act , 1956.

3. Regulation :

The DST shall strive to avoid conflict of interest in its funding mechanisms to the maximum extent possible. Self-regulatory mode is however recommended for stake holders involved in scientific research and research management, on issues pertaining to Conflict of Interest and scientific ethics. Any disclosure pertaining to the same must be made voluntarily by the applicant/Reviewer/Committee Member.

4. Confidentiality :

The Reviewers and the Members of the Committee shall safeguard the confidentiality of all discussions and decisions taken during the process and shall refrain from discussing the same with any applicant or a third party, unless the Committee recommends otherwise and records for doing so.

5. Code of Conduct

5.1 To be followed by Reviewers/Committee Members:

(a) All reviewers shall submit a conflict of interest statement, declaring the presence or absence of any form of conflict of interest.

(b) The reviewers shall refrain from evaluating the proposals if the conflict of interest is established or if it is apparent.

(c) All discussions and decisions pertaining to conflict of interest shall be recorded in the minutes of the meeting.

(d) The Chairman of the Committee shall decide on all aspects pertaining to conflict of interests.

(e) The Chairman of the Committee shall request that all members disclose if they have any conflict of interest in the items of the agenda scheduled for discussion.

(f) The Committee Members shall refrain from participating in the decision making process and leave the room with respect to the specific item where the conflict of interest is established or is apparent.

(g) If the Chairman himself/herself has conflict of interest, the Committee may choose a Chairman from among the remaining members, and the decision shall be made in consultation with Member Secretary of the Committee.

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(h) It is expected that a Committee member including the Chair-person will not seek funding from a Committee in which he/she is a member. If any member applies for grant, such proposals will be evaluated separately outside the Committee in which he/she is a member.

5.2 To be followed by the Applicant to the Grant/Award : (a) The applicant must refrain from suggesting referees with potential Conflict of Interest

that may arise due to the factors mentioned in the specifications described above in Point No. 2.

(b) The applicant may mention the names of individuals to whom the submitted proposal should not be sent for refereeing, clearly indicating the reasons for the same.

5.3 To be followed by the Officers dealing with Programs in DST:While it is mandatory for the program officers to maintain confidentiality as detailed in point no. 6 above, they should declare, in advance, if they are dealing with grant applications of a relative or family member (including but not limited to spouse, child, sibling, parent) or thesis/ post-doctoral mentor or stands to benefit financially if the applicant proposal is funded. In such cases, DST will allot the grant applications to the other program officer.

6. Sanction for violation

3.1 For a) Reviewers / Committee Members and b) Applicant

Any breach of the code of conduct will invite action as decided by the Committee.

3.2 For Officers dealing with Program in DST

Any breach of the code of conduct will invite action under present provision of CCS (conduct Rules), 1964.

7. Final Appellate authority :

Secretary, DST shall be the appellate authority in issues pertaining to conflict of interest and issues concerning the decision making process. The decision of Secretary, DST in these issues shall be final and binding.

8. Declaration

I have read the above “Policy on Conflict of Interest” of the DST applicable to the Reviewer/ Committee Member/ Applicant/ DST Scheme or Program Officer # and agree to abide by provisions thereof.

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I hereby declare that I have no conflict of interest of any form pertaining to the proposed grant *I hereby declare that I have conflict of interest of any form pertaining to the proposed grant *

* & # (Tick whichever is applicable)

Name of the Reviewer/ Committee Member or Applicant or DST Officer(Strike out whichever is not applicable)

(Signature with date)

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FORMAT FOR SUBMISSION OF RESEARCH PROPOSAL...

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