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To be filled by the applicant
Project title
Principle investigator name
Title / position
Institution
Mobile number
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