Application Form for Seed Funding for NMRC Fellowship/MOH

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NMRC Research Training Fellowship/NRF-MOH Healthcare Research
Scholarship
Request for Seed Funding (S$30,000)
All information is treated with 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.
The purpose of this seed funding is to assist the Fellow/Scholar who has completed training
under one of the above programmes, to start a research project using knowledge attained
during the training.
Period of seed funding commences upon the fellow’s return to the institution and is valid for
a period of up to 2 years from the award date.
There will be a call for submission of an annual report and a final report every March for the
funded NMRC Research Training Fellow, and every September for the funded NRF-MOH
Healthcare Research Scholar respectively.
Please ensure that ALL sections of this Form are completed.
1. INFORMATION OF APPLICANT
Name of Applicant (as in the NRIC)
Surname:
Given Name:
Academic Grade
(E.g., Assistant Professor, Associate Professor,
Professor)
Clinical Grade
(E.g., Medical Officer, Registrar, Associate
Consultant, Consultant, Senior Consultant)
Department / Institution
Address of Employer
Type of Fellowship/Scholarship Awarded
NMRC Research Training Fellowship
NRF-MOH Healthcare Research Scholarship (PhD)
Period of Research Training
Start Date: (dd/mm/yyyy)
Completion Date: (dd/mm/yyyy)
Type of Training:
Full-time local post-graduate training
(PhD/MSc/MPH/____ )*
Part-time local post-graduate training
(PhD/MSc/MPH/____ )*
Full-time overseas research
attachment leading to a graduate
degree
(PhD/MSc/MPH/____ )*
Part-time overseas research attachment
leading to a graduate degree
(PhD/MSc/MPH/____ )*
Full-time overseas research
attachment not leading to a degree
2. PROPOSED RESEARCH PROJECT
(i) Research Project Title:
(ii) Key words:
Please provide a maximum of 6 key words related to the research project.
(iii) Detailed Research Proposal:
Please also attach details of the research project, including:

Abstract (200 to 300 words)

Introduction

Aims

Hypotheses

Methodology
The above should be in presented in no longer than 10 pages. References should be attached at the
end of the proposal and does not count towards the page limit. Please present the research proposal
on A4-sized paper, 1-inched margins, single-line spacing and size 12 Times New Roman font.
(iv) Field of Research / Health Category:
Please select up to 5 categories from the following.
Blood
Cancer
Cardiovascular
Congenital Disorders
Ear
Eye
Infection
Inflammatory and Immune System
Injuries and Accidents
Metabolic and Endocrine
Musculoskeletal
Neurological
Oral and Gastrointestinal
Renal and Urogenital
Reproductive Health and Childbirth
Respiratory
Skin
Stroke
Generic Health Relevance
Other : _________________________
(v) Industry link:
Is your project industry-linked?
Yes
No
If yes, please give a description on how your project is industry-linked:
(E.g. name of company, your involvement)
(vi) Information on Research Mentor:
Name:
Email:
Designation:
Phone:
Department:
Institution:
Field of Research / Health Category: [To indicate only if different from section 2(v)]
Please select up to 5 categories from the following.
Blood
Cancer
Cardiovascular
Congenital Disorders
Ear
Eye
Infection
Inflammatory and Immune System
Injuries and Accidents
Metabolic and Endocrine
Musculoskeletal
Neurological
Oral and Gastrointestinal
Renal and Urogenital
Reproductive Health and Childbirth
Respiratory
Skin
Stroke
Generic Health Relevance
Other : _________________________
Please attach the following:

Letter of undertaking from the proposed Research Mentor

CV [to include details of current and pending funding; i.e. name of agency, number of grants
held, grant title, role (e.g. PI or co-PI), grant duration and the awarded budget]

Training record of the Research Mentor (e.g., number of fellows previously trained and number
of fellows currently in training)
3. ETHICAL CONSIDERATION AND CONTAINMENT
Fund disbursement is subjected to ethics approval if the project involves any of the below. Please tick
accordingly if project involves any of the following:
Item requiring ethics approval:
a)
Human Subject
b)
Use of Human/Animal Tissues or Cells from
Primary Donors (i.e. subject/volunteers recruited
for project)
c)
Use of Commercially Available Human/Animal
Tissues or Cells
d)
Animal Experimentation
e)
Requirement for Containment
f)
Multi-centre trial(s)
(If yes, please state all participating
institutions/centres :
)
A copy of the ethics approval for each declared
item is attached:
Yes
No
Please declare the
participating institutions
where study requiring
ethics approval is
conducted:
4a. BUDGET CONSIDERATION
Please provide and estimation of budget under each category. For NMRC Research Training Fellows,
items must be in line with NMRC general fund guidelines. For NRF-MOH Healthcare Research
Scholars, items must be in line with National Research Foundation (NRF) and NMRC general fund
guidelines; and should there be discrepancies, guidelines by NRF will prevail.
Category
FY2011
FY20__
FY20__
Total
(S$)
Manpower
Salary and costs should be as per Human Resource
policies of your Institution.
Equipment
Other Operating Expenses (OOE)
This category covers expenses such as the purchase
of animals, consumables, laboratory manuals,
literature search, maintenance of equipment and
conference travel for a presentation related to the
project.
Grand Total: (S$)
4B. PROTECTED TIME (Specific for NRF-MOH Healthcare Research Scholars only)
NMRC will support salary up to a total of $60,000 based on the protected time for research
required by applicant upon return.
Protected time for research required by applicant:
FTE* / Hours per
week
* Please enter FTE to 1 decimal place. The total work hours per week for a five-day week is
40 hours; 0.1 FTE is equivalent to 4 hours.
5. DECLARATION BY APPLICANT
I DECLARE that, to the best of my knowledge, the information I have provided on this form is true,
accurate and complete.
I consent to the NMRC holding and using the data on this application form together with other
documents attached for the purpose of administering and reviewing my application. I agree that such
data may be made available to those who reasonably need to know within the NMRC and NMRCappointed reviewers.
___________________________________
Signature of Applicant
______________________
Date (dd/mm/yyyy)
6. ENDORSEMENT BY HEAD OF DEPARTMENT
I SUPPORT the above application for the seed funding.
The Department will protect the
Fellow’s/Scholar’s time; provide him/her with the necessary support, facilities and equipment to
enable him/her to continue his/her development in clinical/biomedical research as declared in the
application and/or agreement under the Fellowship/Scholarship.
___________________________________
Signature of Head of Dept
______________________
Date
Name:
7. ENDORSEMENT BY THE INSTITUTION / MEDICAL SCHOOL
I SUPPORT the above application for the seed funding.
The Institution will protect the
Fellow’s/Scholar’s time; provide him/her with the necessary support, facilities and equipment to
enable him/her to continue his/her development in clinical/biomedical research as declared in the
application and/or agreement under the Fellowship/Scholarship.
___________________________________
Signature of Director/CEO of Institution
OR Dean of Medical School*
Name:
* Please delete where appropriate
______________________
Date
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