THE NATIONAL MEDICAL RESEARCH COUNCIL IRG Application Form Name of Principal Investigator: Amount applied for: Error! Reference source not found. NATIONAL MEDICAL RESEARCH COUNCIL Application for Individual Research Grant (IRG) All information is treated in confidence. The information is furnished to the National Medical Research Council with the understanding that it shall be used or disclosed for evaluation, reference and reporting purposes . If your application is not successful, this form will be destroyed after the retention period deemed as appropriate by the Council. 1 Category of research proposal Please ‘click’ the appropriate box a) New Renewal (Grant number NMRC/ Resubmission (Application ID application b) / ) & No. of resubmissions inclusive of current ) Clinical Translational 2 Title of research (Limit to 300 characters) 3 Host Institution 4 Applicants (Please note that Co-Investigators need to hold at least an adjunct position in a local public institution. Researchers from overseas institutions or private companies can only participate as collaborators. Applicant Role Position Department Institution Principal Investigator Co-Investigator Co-Investigator Collaborator Collaborator (Please add more rows if required) 5 Total amount of funds applied for SGD exclusive of indirect cost) 6 Period of Support requested Nov10 (capped at $1.5 M years (max 3 years) Page 2 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 7 Key words (Mandatory. Please provide maximum 6 key words) 8 Field of research Please fill in the Health Research Classification (HRC) System below with reference to the list attached as Appendix 1 in the IRG Guide. The HRC System is adapted from MRC, UK. (A) Health Category You may select up to 5 categories from the followings. Please use the minimum number of codes to reflect the main focus of the research. Blood Cancer Cardiovascular Congenital Disorders Ear Eye Infection Inflammatory and Immune System Injuries and Accidents Mental Health Metabolic and Endocrine Musculoskeletal Neurological Oral and Gastrointestinal Renal and Urogenital Reproductive Health and Childbirth Respiratory Skin Stroke Generic Health Relevance Other (B) Research Activity Code You may select up to 2 sub-codes from the followings, eg, 2.1. 1 Underpinning Research 1.1 Normal biological development and functioning 1.2 Psychological and socioeconomic processes 1.3 Chemical and physical sciences 1.4 Methodologies and measurements 1.5 Resources and infrastructure (underpinning) 2 Aetiology 2.1 Biological and endogenous factors 2.2 Factors relating to physical environment 2.3 Psychological, social and economic factors 2.4 Surveillance and distribution 2.5 Research design and methodologies (aetiology) 2.6 Resources and infrastructure (aetiology) Nov10 Page 3 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 3 Prevention of Disease and Conditions, and Promotion of Well-Being 3.1 Primary prevention interventions to modify behaviours or promote well-being 3.2 Interventions to alter physical and biological environmental risks 3.3 Nutrition and chemoprevention 3.4 Vaccines 3.5 Resources and infrastructure (prevention) 4 Detection, Screening and Diagnosis 4.1 Discovery and preclinical testing of markers and technologies 4.2 Evaluation of markers and technologies 4.3 Influences and impact 4.4 Population screening 4.5 Resources and infrastructure (detection) 5 Development of Treatments and Therapeutic Interventions 5.1 Pharmaceuticals 5.2 Cellular and gene therapies 5.3 Medical devices 5.4 Surgery 5.5 Radiotherapy 5.6 Psychological and behavioural 5.7 Physical 5.8 Complementary 5.9 Resources and infrastructure (development of treatments) 6 Evaluation of Treatments and Therapeutic Interventions 6.1 Pharmaceuticals 6.2 Cellular and gene therapies 6.3 Medical devices 6.4 Surgery 6.5 Radiotherapy 6.6 Psychological and behavioural 6.7 Physical 6.8 Complementary 6.9 Resources and infrastructure (evaluation of treatments) 7 Management of Diseases and Conditions 7.1 Individual care needs 7.2 End of life care 7.3 Management and decision making 7.4 Resources and infrastructure (disease management) 8 Health and Social Care Services Research 8.1 Organisation and delivery of services 8.2 Health and welfare economics 8.3 Policy, ethics and research governance 8.4 Research design and methodologies 8.5 Resources and infrastructure (health services) Nov10 Page 4 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 9 Ethical considerations and containment Fund disbursement is subjected to ethics approval if the project involves any of the below. Please declare the participating institutions where study requiring ethics approval is conducted: Please tick accordingly if project involves any of the following: a) Human Subject Yes No b) Use of Human/Animal Tissues or Cells Yes No Yes No d) Animal Experimentation Yes No e) Requirement for Containment Yes No f) Multi-centre trial(s) Yes No from Primary Donors (i.e. subject/volunteers recruited for project) c) Use of Commercially Available Human/Animal Tissues or Cells (If yes, please state all participating institutions/centres : ) A copy of the ethics approval is attached: Yes Nov10 No Page 5 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 10 Abstract In no more than 300 words, concisely describe the specific aims, hypotheses, methodology and approach of the research proposal including its importance to science or medicine in particular clinical significance. The abstract must be self-contained so that it can serve as a succinct and accurate description of the research proposal. Note that the scientific abstract may be disclosed to other funding agencies. Nov10 Page 6 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 11 Research proposal In no more than 12 pages (for sections 11.1 to 11.5), organize the details of the research proposal under the following headings (Please use Arial Font size 10 for all text): 11.1 Specific aims 11.2 Clinical significance 11.3 Preliminary studies/Progress reports 11.4 Methods 11.5 Roles of Team Members 11.6 References For Resubmission and Renewal (follow up study from NMRC projects) applications, append the following documents to the end of this application as Annexes: Resubmission – A document itemizing how the revised proposal (i.e. re-submission application) has addressed past reviewers’/panel’s comments and highlight new features or merits of the revised proposal. (Annex B) Reviewers’ report of previous unsuccessful application; Rebuttal to the external reviewers; Panel’s comments (where applicable); and Response to the panel (where applicable) (in the above order as Annex C) Renewal – Submit a progress/final report of the existing project to indicate the progress and outputs of the project in the prescribed NMRC reporting format (i.e. progress/ final report). (Annex D) Please note that additional information/data may be attached as Annex E. However, they may or may not be assessed by the reviewers/panel. ===================================================================================== 1 Specific Aims State concisely and realistically what the pilot study intends to accomplish and/or what hypothesis is to be tested. 2 Clinical Significance Briefly sketch the background of the research proposed, critically evaluate existing knowledge and specifically identify the gaps which the project intended to fill. State concisely the importance of the research described by relating the specific aims to both short term (3-5 years) and possible long term clinical implications. Describe how your research will contribute to: (i) (ii) (iii) (iv) solving the health problem; develop new knowledge; develop scientific and clinical applications; and provide tangible improvements in life sciences/healthcare. 3 Preliminary Studies/Progress Reports For NEW APPLICATIONS, provide an account of the Principal Investigator’s preliminary studies (if any) pertinent to the applications and/or any other information that will help to establish the experience and competence of the investigator pursuing the proposed project. For RENEWAL APPLICATIONS, give the beginning and end dates of the period covered since the research project was last reviewed. Provide a succinct account of published and unpublished results, indicating the importance of the findings. Discuss any changes in the project’s specific aims during the periods covered. List the titles and complete references to all publications and completed manuscripts that have resulted from the project. Nov10 Page 7 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 4 Methods Describe the following in detail (refer to statistical checklist found in Appendix 2 of the Guide for IRG Application for study design): (i) (ii) (iii) (iv) (v) experimental design and the procedure, any new methodology and its advantage over existing methodologies, the potential difficulties and limitations of the proposed procedures and alternative approaches to achieve the aims, any procedures, situations or materials that may be hazardous to personnel and the precautions to be exercised, statistical justification and the means by which data will be analysed and interpreted. 5 Roles of Team Members Elaborate (in one paragraph) the role of Co-Investigators and Collaborators involved in the project. Specify the research background, technical competencies, role and contribution to specific deliverables and achievements that are relevant and necessary to ensure success for the proposed research. 6 References Please list the references in the order cited in this proposal, including the titles. Nov10 Page 8 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 12 Work Contribution of PI & Team Members Please provide the expected percentage effort within the project, as well as within his/her other work commitments for each Principal Investigator, Co-Investigator(s) and Collaborator(s). Note that Co-Investigators need to hold at least an adjunct position in a local public institution. Researchers from overseas institutions or private companies can only participate as collaborators. The terms of collaboration with overseas research institutions and private companies must conform to NMRC’s existing policies. Name Role in project (e.g. PI, CoInvestigator, Collaborator) Institn % effort within project1 Total 100% % effort within own work commitments2 Elaborate on their contribution to the project 1 NOTE: Represents percentage effort spent by the team members in the project relative to his/her other team members. The total in this column must add up to 100%. NOTE: Represents percentage effort spent by the team members on this project out of individual’s total work commitments (e.g. other grants, other teaching and administrative responsibilities, clinical work etc.) 2 Nov10 Page 9 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 13 Biographical Sketch (a) Principal Investigator Please use the format below to provide the required information on Principal Investigator. NMRC places emphasis on the bold areas. Please limit to 2 pages. Name Title NRIC/Passport No. Office Mailing Address Email Contact No Current Position (Please provide full details, e.g. joint appointments; other academic appointments including those outside of Singapore; percentage of time spent in Singapore every year, if applicable) Employment History Academic qualifications (Indicate institution’s name and year degree awarded) Research interests Publications in the last 5 years (include only publications of direct relevance to study, stating impact factors where possible) Patents held (related or unrelated to the study) Scientific Awards Current and previous support from NMRC or other sources – See Section 14 (Please also include proposals pending approval) Research Outcomes from other grants (e.g. publications, patents, awards, etc) (b) Co-Investigator and Collaborators In not more than 1 page per applicant, please use the format below to provide the required information on the Co-Investigators and Collaborators .Note that Co-Investigators need to hold at least an adjunct position in a local public institution. Researchers from overseas institutions or private companies can only participate as Collaborators. Name Title NRIC/Passport No. Office Mailing Address Email Contact No Current Position (Please provide full details, e.g. joint appointments) Academic qualifications (Indicate institution’s name and year degree awarded) Research interests Publications of direct relevance to the study Relevant patents held related to the study Scientific Awards Current and previous support from NMRC or other sources (Please also include proposals pending approval) Nov10 Page 10 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 14 Budget You are advised to prepare the budget carefully under each category and provide the justifications for all categories in Item 14.4. Please refer to the annex in the NMRC Policy Document on Financial Regulations for this section. The provision of indirect research cost (IRC) will be computed at the budget revision phase when the project is approved. 14.1 Manpower Please budget for all the manpower required for the project including part-time personnel and those to be shared with other projects. State whether they are existing personnel in your institution or new staff to be recruited. Please use salary scales provided by the Bursar’s Office or Hospital Administration as a reference. The cost should include annual increments, National Service increment, staff welfare, medical and other related benefits as per the Human Resource policies of your institution. Staff Category Existing/New Technologist New Research Assistant New Research Officer New Research Associate New Research Nurse New Postdoctoral Fellow New Visiting Consultant New Others: (please specify) New No Remarks Total cost Total Nov10 $0.00 Page 11 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 14.2 Equipment Please budget for all scientific equipment you need to purchase to carry out the project. Indicate sharing of equipment with other projects, if any. For equipment costing more than $100,000 each, please indicate the estimated utilization of the equipment (e.g. 70% usage throughout the project period; only 85% usage in the 2nd year for analysis purpose, etc) Qty Equipment Estimated Utilisation Rate for Equipment more than $100,000 (to be justified) Unit Cost Total Nov10 Sub- Total $0.00 Page 12 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 14.3 Other Operating Expenses (OOE) This category covers other expenses directly related to the project such as the purchase of animals, consumables, laboratory manuals, literature search, and maintenance of equipment. Conference travel will be funded only if a presentation or if an article is presented and is capped at $6,000 per trip per requested year. The presentation or article must be directly related to the project. Item Description Cost Materials & Consumables Overseas Travel Others: (please specify) Total $0.00 Grand Total: SGD$0.00 Nov10 Page 13 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 14.4 Details and Justifications of Budget Requested Please provide breakdown for all categories if this is not indicated in the tables. 14.4.1 Manpower Justifications 14.4.2 Equipment Justifications 14.4.3 Other Operating Expenses (OOE) Justifications Materials & Consumables Overseas Travel Others e.g. Singapore Clinical Research Institutes (SCRI) cost Nov10 Page 14 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 15 Milestones Please propose Milestones for assessment of the progress of the study and shade the appropriate boxes. The progress of the project will be taken into consideration for continued disbursements of funds. Targeted Duration Milestones Year 1 Q1 Q2 Q3 Year 2 Q4 Q1 Q2 Q3 Year 3 Q4 Q1 Q2 Q3 Q4 Eg. Milestone 1 (please replace) Eg. Milestone 2 (please replace) Eg. Milestone 3 (please replace) Nov10 Page 15 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 16 Performance Indicators Please indicate the final expected targets. Please state ‘NA’ where indicator is not applicable. Indicate number / value Performance Indicators Master’s research students trained PhD students trained * Training R&D manpower for industry Master’s research and PhD students trained and spun out to local industry as RSEs (Research Scientist & Engineer) Research staff spun out to local industry as RSEs Post-doctoral (within 3 years of the PhD award) researchers hired Joint programs/projects with prestigious international research organizations Joint programs/projects with local universities Capability Indicators Invention disclosures Patents filed Developing long term R&D capability Patents granted Patents commercialized Papers published in international journals * (To state impact factor) Presentations at international conferences Awards for research at national and international level R&D collaboration Industry Relevance Indicators R&D projects with industry cash funding Industry dollars received to fund R&D projects Revenue from royalties and licensing agreements Outcomes Spin-off companies registered New products or processes commercialized *NMRC places special emphasis on these targets. Nov10 Page 16 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 17 Other Support Please provide the following details for the grants currently held or being applied for by the Principal Investigator. Attach additional pages if necessary. Please attach the scientific abstracts of each grant listed below in (a) – (d) and required additional information as Annex A for Council’s reference. Missing abstracts / KPIs / attachments will render this application incomplete. (a) Support from any industry partner(s) Please provide details on the funding/drug(s) or other resources provided by any participating industry partner(s) for the applied grant. Items Supported Funding Source Support Period (Year) Amount of Fund ($) (b) Grants currently held (NMRC & Other Institutions) Specifically for NMRC-funded projects, please indicate the NMRC project number and provide the latest research outcomes (Key Performance Indicators) as a separate attachment. Title of Research Funding Agency Amount of Fund Approved/ Received ($) Balance Available ($) Support Period (Year) Expiry Date of the grant (c) List all applied grants (e.g. NMRC, NRF, A*STAR, MOE, Clusters, etc) where outcome is pending For all NMRC grant applications, please indicate application ID. Please indicate all the applied grants of similar proposal where the applicant is involved as either PI, Co-Investigator or Collaborator and provide any overlapping sections in the proposals as a separate attachment. Title of Research and PI’s role in project Nov10 Application ID Funding Agency Amount of fund applied for ($) Support Period (Year) Page 17 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. (d) Support not related to specific research projects Provide details of ALL other support which are not derived from funds provided for specific research projects, such as departmental technicians, grants from private foundations, start-up funds, donations from charitable organizations, etc. You may also attach correspondences showing commitments by other parties in support of your work. Types of resources Nov10 Funding Organisations Duration of support Expiry date, if any Page 18 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 18 Conflict of Interest Please provide name and contact information of individuals who might have conflict of interests with your current research proposal. This includes competitors who are in your specific area of research S/N Title Name Details (Institution and e-mail add) Reason for COI 1 2 3 19 Suggested names of Reviewers (Mandatory) Reviewers who are co-authors with the PI(s) in publications are generally not to be included. Note that reviewers must not have conflict of interest or involvement (direct and indirect) with the proposed project. NMRC has the final discretion whether to select the suggested reviewers for the evaluation of the grant proposal. S/N Title Name Details (Institution and e-mail add) Relationship to Principal Investigator 1 2 3 4 5 Nov10 Page 19 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 20 Institutional support In signing the Grant Application, the Institution UNDERTAKES, on any Grant Award, to: Discuss with immediate supervisor of applicant that the following will be complied with: o The proposed research will be conducted in the host institution o Adequate resources will be provided to the applicant for the entire grant period (e.g. lab space) o The applicant is independently salaried by the institution for the entire period of the grant o The research abides by all laws, rules and regulations pertaining to national and the institution's research operating procedures and guidelines o Confirm the accuracy and completeness of information submitted, including budget, ethics, other funding sources, etc. o Confirm that budget is clear (e.g. no double funding/ excessive purchase of equipment), and is aligned with host institution HR and other policies Research Director (or designated officer in capacity of providing institutional support): _____________________ ___ Date: __________________ Name, Designation & Signature Comments: Nov10 Page 20 of 21 Name of Principal Investigator: Amount applied for: Error! Reference source not found. 21 Signatories In signing the Grant Application, the Principal Investigator and all Co-Investigator(s) & Collaborator(s) UNDERTAKE, on any Grant Award, to: Declare that all information is accurate and true. Not send similar versions or part(s) of this proposal to other agencies for funding. Submit supporting documents of ethics approval obtained from the relevant Institutional Review Board (IRB) and Animal Ethics Committee for studies involving human subjects/human tissues or cells, and animal/animal tissues or cells respectively. Be actively engaged in the execution of the research and comply with all laws, rules and regulations pertaining to animal and human ethics, including the Singapore Good Clinical Practice guidelines. Ensure that National Medical Research Council (NMRC) funding is acknowledged in all publications. Ensure that all publications arising from research wholly or partly funded by NMRC will be forwarded to NMRC. Ensure that the requested equipment/resources are not funded by another agency or research proposal. Ensure that there is a reasonable effort in accessing available equipment/resources within the host institution or elsewhere within Singapore. Adhere to NMRC’s general guidelines on competitive funding and NMRC’s Terms and Conditions. The undersigned agree to abide by the conditions governing the award of research grants set out by the National Medical Research Council (NMRC) of Singapore. _______________ _______________ _______________ ______________ Principal Investigator Name: Date: Co-Investigator Name: Date: Co-Investigator Name: Date: Co-Investigator Name: Date: _______________ _______________ _______________ ______________ Co-Investigator Name: Date: Co-Investigator Name: Date: Co-Investigator Name: Date: Co-Investigator Name: Date: _______________ _______________ _______________ ______________ Collaborator Name: Date: Nov10 Collaborator Name: Date: Collaborator Name: Date: Collaborator Name: Date: Page 21 of 21