crest research application form R&D Projec… · Web viewReference No: CREST RESEARCH APPLICATION FORM One (1) hardcopy and softcopy of this form must be submitted to the Collaborative

CREST RESEARCH APPLICATION FORM (MAY 2012)

CREST RESEARCH APPLICATION FORM

One (1) hardcopy and softcopy of this form must be submitted to the Collaborative Research in Engineering, Science & Technology (CREST) Center, Research & Development Division, Block C, Ground Floor, SAINS@USM, No. 10 Persiaran Bukit Jambul, 11900 Bayan Lepas, Penang, Malaysia. (http://www.mycrest.com.my)

[Incomplete Applications will be rejected]

A TITLE OF PROPOSED RESEARCH:TAJUK PENYELIDIKAN YANG DICADANGKAN:

B NAME OF ORGANISATION / NAMA ORGANISASI

C DETAILS OF RESEARCHER / MAKLUMAT PENYELIDIK

C(i) Name of Project Leader:Nama Ketua Projek:

C(ii) Position:Jawatan:

C(iii) Office Telephone No.: No. Telefon Pejabat:

Handphone No.: No. Telefon Bimbit:

C(iv)

E-mail Address:Alamat e-mel:

Mailing Address:Alamat surat-menyurat:

Reference No:


D COMPANY INFORMATION / MAKLUMAT SYARIKAT

D(i) Company Name: Nama Syarikat:

D(ii) Address:Alamat:

D(iii) Company No.:No. Syarikat:

D(iv) Brief description of Company:Keterangan ringkas mengenai syarikat:

D(v) Company’s role in the project:Peranan syarikat dalam projek:

Note: Please attach a support letter signed by Company’s top management. Nota: Sila sertakan bersama surat sokongan yang ditandatangani oleh pengurusan atasan syarikat.


E ACADEMIA INFORMATION / MAKLUMAT AKADEMIA

E(i) Unversity Name: Nama Universiti:

E(ii) Address:Alamat:

E(iii) Brief description of University:Keterangan ringkas mengenai Univeristi:

E(iv) University’s role in the project:Peranan universiti dalam projek:

Note: Please attach a support letter signed by University’s head of department/dean. Nota: Sila sertakan bersama surat sokongan yang ditandatangani oleh ketua jabatan/dekan di Universiti.


F RESEARCH INFORMATION / MAKLUMAT PENYELIDIKAN

F(i) Research Area (Please tick ( √ )):Bidang Penyelidikan (Sila tanda ( √ )):

A. Science (Sains)

Chemistry Physic Material Science (Kimia) (Fizik) (Sains Bahan)

Mathematics and Statistics Computer Science Others (Matematik dan Statistik) (Sains Komputer) (Lain-lain)

B. Technology and Engineering (Teknologi dan Kejuruteraan)

Mechanical & Manufacturing Electrical and Electronic Civil Engineering (Mekanikal dan Pembuatan) (Elektrikal dan Elektronik) (Kejuruteraan Awam) Material and Polymer Chemical Engineering Information and Communication (Bahan dan Polimer) (Kejuruteraan Kimia) Technology (Teknologi Komunikasi dan

Informasi) Energy Transportation Others (Tenaga) (Pengangkutan) (Lain-lain)

C. Industrial Cluster

IC Design Embedded LED / SSL Solar RF & Wireless M&E Test & Measurement Others

F(ii) Location of Research:Tempat penyelidikan dijalankan:


F(iii) Duration of this research (Maximum 24 months): Tempoh masa penyelidikan ini (Maksimum 24 bulan):

Duration: ________________ Tempoh : From : _________________ Dari :

To : ________________ Hingga :

F(iv) Other Researchers:Ahli-ahli penyelidik yang lain:

Bil NameNama

OrganisationOrganisasi

PositionJawatan

Academic Qualification/Designation

Tahap Kelayakan Akademik/Jawatan

Signature Tandatangan

1

2

3

4

5

6


F(v) Executive Summary of Research Proposal (maximum 300 words) (Please include the background of research, literature reviews, objectives, research methodology and expected outcomes from the research project)

Ringkasan Cadangan Eksekutif Penyelidikan (maksima 300 patah perkataan)(Meliputi latar belakang penyelidikan, kajian literatur, kaedah penyelidikan, objektif dan jangkaan hasil penyelidikan)


F(vi) Detailed proposal of research project:Cadangan maklumat penyelidikan secara terperinci:

(a) Research background including Problem statement and research methodology. Keterangan latar belakang penyelidikan termasuk persoalan penyelidikan dan kaedah penyelidikan.

(b) Objective (s) of the Research Objektif Penyelidikan

Example /Contoh: This study embarks on the following objectives:

1) To investigate ......

2) To assess..........

3) To investigate ......

4) To make recommendation based on ......................

(c) Methodology Kaedah penyelidikan

Please state in the form / Sila nyatakan di borang ini

1. Description of Methodology

2. Flow Chart of Research Activities ( Please enclose in the Appendix)

3. Gantt Chart of Research Activities (Please enclose in the Appendix)

4. Milestones and Dates

(d) Expected Results/Benefit Jangkaan Hasil Penyelidikan

1. Benefit to local companies / industry wide

2. Commercialization / New Technology / New Processes / New Talent

3. Specific or Potential Applications

4. Number of PhD and Masters (by research) Students

5. Publications (at least 3 publications)

6. Intellectual Property


G ACCESS TO EQUIPMENT AND MATERIAL (ACCESSIBILITY TO THE UNIVERSITY AND INDUSTRY) KEMUDAHAN SEDIA ADA UNTUK KEGUNAAN BAGI PENYELIDIKAN INI(KEMUDAHAN SEDIA ADA DI UNIVERSITI DAN INDUSTRI)

Equipment Peralatan

LocationTempat


H BUDGET / BELANJAWAN

Please indicate your estimated budget for this research and details of expenditure according to the guidelines attached.Sila nyatakan anggaran bajet bagi cadangan penyelidikan ini dan berikan butir – butir perbelanjaan lengkap dengan berpandukan kepada garis panduan yang dilampirkan.

Budget detailsButiran

belanjawan

Amount requested by applicant

Jumlah yang dipohonoleh pemohon

Industry contributionSumbangan Industri

Amount approved byCREST Steering

Committee Jumlah yang diluluskan oleh

Jawatankuasa Pemandu CREST

Year 1Tahun

1 (RM)

Year 2Tahun 2

(RM)

TotalJumlah (RM)

Year 1Tahun

1 (RM)

Year 2Tahun

2 (RM)

TotalJumlah (RM)

H(i) Allowances(Emoluments)Elaun dan emolumen

Please specifySila nyatakan secara lengkap dengan pecahannya sekali.

H(ii) Other personnel cost (travel, transport, accomodation etc.)Kos kakitangan yang lain (termasuk perjalanan dan pengangkutan, penginapan dll.)




belanjawan




CREST Steering Committee

Jumlah yang diluluskan oleh Jawatankuasa Pemandu

CREST

Year 1Tahun

1 (RM)

Year 2Tahun 2

(RM)

TotalJumlah (RM)

Year 1Tahun

1 (RM)

Year 2Tahun

2 (RM)

TotalJumlah (RM)

H(iii) Rental(space, equipment, software etc.)Sewaan(ruang, peralatan, perisian dll.)


H(iv) Procurement of EquipmentPembelian peralatan


H(v) Procurement of SoftwarePembelian perisian

Please specifySila nyatakan secara lengkap dengan pecahannya sekali




belanjawan




CREST Steering CommitteeJumlah yang diluluskan

oleh Jawatankuasa Pemandu CREST

Year 1Tahun

1 (RM)

Year 2Tahun 2

(RM)

TotalJumlah (RM)

Year 1Tahun

1 (RM)

Year 2Tahun

2 (RM)

TotalJumlah (RM)

H(vi) Procurement of Research material (disposables) and othersPembelian bahan penyelidikan dan lain-lain


H(vii) Maintenance and repairsBaik pulih kecil dan ubahsuai




belanjawan




CREST Steering CommitteeJumlah yang diluluskan

oleh Jawatankuasa Pemandu CREST

Year 1Tahun

1 (RM)

Year 2Tahun 2

(RM)

TotalJumlah (RM)

Year 1Tahun

1 (RM)

Year 2Tahun

2(RM)

TotalJumlah (RM)

H(viii) Miscellaneous (anything else not covered)Lain-lain


TOTAL AMOUNTJUMLAH BESAR

Note:

THE INDUSTRY IS ENCOURAGED TO CONTRIBUTE FOR THE RESEARCH. CONTRIBUTIONS IN THE FORM OF FINANCIAL FUNDS, EXPERTISE, EQUIPMENT, SERVICES ETC. NEED TO BE TRANSLATED IN VALUE OF FINANCIAL CONTRIBUTION

Notes for H(iv) Procurement of equipment, research material, etc.:1. Quotation for equipment and software shall be provided.2. Equipment and software descriptions and the potential users shall be provided.3. Please specify if the equipment is dedicated to a specific industry.

Nota:

INDUSTRI DIGALAKKAN UNTUK MEMBERI SUMBANGAN DI DALAM PENYELIDIKAN INI. SUMBANGAN DALAM BENTUK DANA KEWANGAN, KEPAKARAN, PERALATAN, KHIDMAT DAN SEBAGAINYA PERLU DITERJEMAHKAN DALAM NILAI SUMBANGAN KEWANGAN.

Nota untuk H(iv) Pembelian peralatan, bahan penyelidikan dll.:1. Sebutharga untuk peralatan dan perisian perlu dikemukakan.2. Keterangan mengenai peralatan dan perisian serta pengguna perlu dinyatakan.3. Sila nyatakan samada peralatan yang dibeli hanya khas untuk kegunaan industri tertentu sahaja.


4.

I Declaration by applicant / Akuan Pemohon(Please tick ( √ )): / (Sila tanda ( √ )):

I hereby declare that:Saya dengan ini mengaku bahawa:

1. All information stated here are accurate, CREST has right to reject or to cancel the offer without prior notice if there is any inaccurate information given. Semua maklumat yang diisi adalah benar, CREST berhak menolak permohonan atau membatalkan tawaran pada bila-bila masa sekiranya keterangan yang dikemukakan adalah tidak benar.

2. Application of this CREST R&D grant is also presented for the other reasearch grant/s (grant’s name and total amount)Permohonan projek penyelidikan ini juga dikemukakan untuk memohon peruntukan geran penyelidikan dari (nama geran dan jumlah dana)____________________________________

Date : Applicant’s Signature :Tarikh : Tandatangan Pemohon : ___________________________


J Recommendation by CREST Technical Advisory PanelPerakuan oleh CREST Panel Penasihat Teknikal

Please tick ( √ ) Sila tandakan ( √ )

Recommended:Diperakukan:

A. Highly Recommended Sangat Disokong

B. Recommended Disokong

C. Not Recommended (Please specify reason) Tidak Disokong (Sila Nyatakan Sebab)

Comments:Ulasan:

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Name: Signature:Nama: Tandatangan:

Date:Tarikh:

Note: APPLICATIONS SUBMITTED WILL BE TREATED IN FULL CONFIDENCE. THE DECISION OF THE CREST STEERING COMMITTEE IS FINAL.


CHECKLIST FOR CREST RESEARCH APPLICATION FORM

1) One (1) set of hardcopy CREST Research Application Form

2) One (1) set of softcopy CREST Research Application Form

3) Letter of Support signed by Company’s top management

4) Letter of Support signed by University’s head of department / dean

5) Company’s Profile

6) University’s Profile

7) Minimum three (3) quotations for procurement of equipment.

8) Minimum three (3) quotations for procurement of software.

9) Minimum three (3) quotations for procurement of research materials.

10) Minimum one (1) quotations for rental of equipment.

11) Minimum one (1) quotations for rental of software.

12) Minimum three (3) quotations for professional services.

13) Curriculum Vitae for every researchers.

14) Role of Project Leader and co-researchers to be stated individually.

15) Role of each student (Master or PhD) in the project to be stated

individually, including their proposed thesis title.

Documents

crest research application form R&D Projec… · Web viewReference No: CREST RESEARCH APPLICATION FORM One (1) hardcopy and softcopy of this form must be submitted to the Collaborative