Sultan Qaboos University
Medical Research and Ethics Committee
MREC#:
Research Proposal Form
Date Rcvd:____________
Applications should be written as concise and specific as possible. Extra pages may be
used if necessary
Project title:
Investigator(s)
Principal
Name
Grade
Department
Co-investigator
Co-investigator
Co-investigator
Experimental model system:
(please tick off)
Population Based
Patients
In vitro
Medical records
animals
Key words:
Ethical Issues
Humans:
If yes, please fill in pages 12-14
Animals:
If Yes: Approved
Requested
Costs:
Equipment
Consumables
Staff
Others
1st year
2nd year
3rd year
Sum:
Total cost
Through the Heads of Departments:
Name: ___________________ Name: ______________________ Name: ____________________ Name: ______________________
Sign: ____________________ Sign: _______________________ Sign: _____________________ Sign: ______________________
Date: ____________________ Date: _______________________ Date: _____________________ Date: _____________________
Page
1
Summary of the project plan (maximum one page)
Summarise the purpose of project, plan of investigation, importance in general, and
importance for Oman.
Page
2
1
Introduction
1.1
Background, previous relevant results/publications by others (Medline search
recommended)
(maximum 4 pages)
Page
3
1.2
Purpose of the Project
1.3
Importance in general
1.4
Importance for Oman
1.5
Previous Preliminary Results by the Applicant (s) (Pilot Study)
Page
4
2
Plan of Investigation
2.1
Human subjects
If yes;
(maximum 4 pages)
Will experiments be performed on human subjects?
Healthy subjects
Patients
Yes
No
Both
2.1.1 Methods of selection (e.g. inclusion/ exclusion criteria), number of groups, and
number of subjects in each group
2.2
Experimental Animals
If Yes
2.3
Biohazards
Will Experiments be performed on animals?
Species:
Yes
No
Number annually:
Will experiments be performed with?
Recombinant DNA clones
Radiation (Particles/ photons)
Radioactive isotopes
Micro-organisms
Toxic chemicals
Others
Are necessary permits available?
Yes
No
Are necessary technicians available?
Yes
No
Page
5
2.4
Protocol of investigations (use more space if needed)
Page
6
2.5
Statistical analysis
2.6
Duration of the project
Page
7
3
Investigators
3.1.1 Experience of the investigators /departments in this field of research and
responsibilities of each participant (use more space if needed)
list the qualifications of each investigator, their experience in the field of research and
a list of key publications of the principal investigator in the field of proposed
investigation
4 Publication of results (proposed journal (s) to be submitted)
Page
8
5 Budget
Details of grant requested: Costs to include salaries, allowances, travel, etc. as
applicable.
5.1
(a)
Personal support of applicant(s)
Name
(b)
2nd year
3rd year
Total
Grade
1st year
2nd year
3rd year
Total
Grade
1st year
2nd year
3rd year
Total
Technical/other assistance
Staff Category
(d)
1st year
Research staff (medical/scientific)
Name
(c)
Grade
Qualification
Visiting senior scientist(s)
Name
Country
Expenses
Equipment/Apparatus
Present position
Period of visit
1st year
2nd year
Cost
3rd year
Support from other source
Total
Consumables
Animals
Scientific Meetings
Other
Total Cost
Page
9
5.2
Justification of proposed expenses
(use more space if necessary)
Page
10
6
Scientific references pertinent to this project (Maximum two pages)
Names & Signatures
Name
Signature
Date
Principal Investigator
Co-investigator
Co-investigator
Co-investigator
Page
11