Address:
UMCG
Sector F
Junior Scientific Masterclass
Huispostcode FC40
P.O. Box 196
9700 AD Groningen
Application form
Pilot Project (6 ECTS)
T (050) 363 6962
www.jsmgroningen.nl
Date of application:
(dd-mm-yyyy)
Deadline date Pilot project
Basic information
1a. Applicants/research supervisors (max. 3):
title, initials, last name, member of Graduate School Medical Sciences, research institute (GUIDE,
BCN, SHARE, CRCG or Kolff Institute), indicate whether (Y)PI or not1.
Main applicant (PI):
Other applicants:
1b. Site of research/mailing address:
Research department (department, research institute, address, telephone number, e-mail address main
applicant):
1c. Name of student (first name, initials, last name, telephone number (land line and/or mobile), email address (only use your…@student.rug.nl):
1d. Project code number2:
1e. distribution teaching hours over the (Y)PIs (with a maximum of 30 hrs in total, maximum of 3
(Y)PIs):
1f. Title of research proposal:
1g. Summary of research proposal (max. 400 words):
Research proposal (max. 4 A4; add tables/figures as appendices)
2a. Research period:
Research project takes place from
to
(dd-mm-yyyy)
2b. Introduction3:
2c. Problem definition/research question/goal/working hypothesis:
2d. Study design (incl. the research subjects (e.g. patients/animals), the comparison made, the
primary and secondary outcomes, power analysis and an overview of the data to be collected and a
statistical plan):
2e. Work plan4 (incl. time planning):
2f. Are there any licences needed for the execution of the pilot project (Local Medical Ethical
Committee (METc), Local Committee for Experiments on Animals (DEC), other)? (without approval the project
cannot be awarded)
Licence type:
approval (yes/no):
2g. Expected results:
2h. Literature/references (max. 10):
2i. Budget5:
Curriculum Vitae
3a. Personal details of student:
Personal details (first name, initials, last name):
Male/female:
Place and date of birth:
Nationality:
3b. BSc degree programme:
Student number:
Degree programme (Medicine/IBMG/Dentistry):
University:
Start date:
(Expected) bachelor graduation date:
Year:
BSc certificate? (yes/no)
3c. If applicable: Title, supervisor, department and research period of the IBMG Bachelor
thesis:(a pilot project may not, in any part, overlap with the IBMG Bachelor thesis.)
3d. Other courses/activities/degree programmes (courses/activities within or outside the JSM
programme and/or other Bachelor’s or Master’s degree programmes):
3e. Research experience:
Signatures
Name of main applicant ((Y)PI)6:
Date:
Signature:
Name of student6:
Date:
Signature:
Accepted by the JSM (yes/no):
Name:
Date:
Signature:
Return to:
University Medical Center Groningen
Sector F
JSM Secretariat
Huispostcode FC40
P.O. Box 196
9700 AD Groningen
tel: (050) 363 6962
e-mail: j.s.masterclass@umcg.nl
website: www.jsmgroningen.nl
1
A Pilot Project must be applied for by a researcher who is employed as '(young-)principal investigator' ((Y)PI) by one of
the five institutes (GUIDE, BCN, SHARE, CRCG and Kolff Institute) of the UMCG’s Graduate School Medical Sciences.
2
The Project code number or cost centre number (kostenplaatsnummer) of the research department concerned. Without this
number the application will not be taken into consideration. After approval of the student’s project report by the JSM
Programme group, the (partial) compensation for the research costs will be remitted to this project code number.
3
The Introduction section should comprise a short description of the scientific background of the proposed research. It must
clearly state what is already known about the research subject. Additionally, the relevance of the research (project) must be
explained.
4 The
Work plan should describe the activities (with time planning) which the student will undertake as part of the research
project. It must be clear what the student him/herself will be doing.
5 The
Budget section should outline the costs of the proposed research, for example costs for antibodies used in lab tests or
other bench fees.
6 Return
the completed and signed form to the JSM Secretariat. After conclusion of the project, a short project report (in the
form of the Pilot project Final report form, available on the JSM website) must be submitted to the JSM Secretariat.
If the students feels the need for a brief evaluation meeting with the study advisor or the JSM deems this necessary, such a
meeting will be part of the conclusion of the research project.