MEDICAL UNIVERSITY
OF BIAŁYSTOK
ul. Jana Kilińskiego 1, 15-089 Białystok
Tel. 85 748 54 15, fax 85 748 54 16
e-mail: cir.know@umb.edu.pl
APPLICATION FOR
THE FINANCING OF A DIDACTIC AND RESEARCH PROJECT
FROM THE PRO-QUALITY GRAND KNOW
1) PROJECT TITLE
.............................................................................................................................................................
.............................................................................................................................................................
2) PROJECT AUTHOR
First name and surname: ...................................................................................................................
Title/Degree: ......................................................................................................................................
Department: .......................................................................................................................................
(Scientific achievements)
3) AREA OF RESEARCH
□ neoplastic diseases/mutagenesis
□ cardiovascular diseases
□ neurodegenerative diseases
□ metabolic diseases
□ other, if other please specify: …………………………………………………………………..……
4) METODOLOGY OF RESEARCH
□ metabolomics/lipidomics
□ proteomics
□ immunology
□ transcriptomics
□ genomics
□ molecular biology
□ biostatistics/bioinformatics
□ other, if other please specify: …………………………………………………………………..……
MEDICAL UNIVERSITY
OF BIAŁYSTOK
ul. Jana Kilińskiego 1, 15-089 Białystok
Tel. 85 748 54 15, fax 85 748 54 16
e-mail: cir.know@umb.edu.pl
5) OTHER PEOPLE INVOLVED IN THE PROJECT
INCLUDING STUDENTS / PhD STUDENTS
(Title, degree, first name and surname, Department, position)
6) DESCRIPTION AND JUSTIFICATION FOR THE PROJECT
Planned time frame for realization: ........................................................................................
Objectives and aims of research:
(Indicate cohesion with research topics included in the KNOW application form)
Methodology:
The didactic and research project is subject to evaluation of:
□ Bioethics Committee
(date of obtaining the Committee's consent: ……………………..…………….)
□ Local Ethics Committee for Experiments on Animals (LEC)
(date of obtaining the Committee's consent: ……………………..…………….)
□ Does not apply, because pertains to tissues sampled in the course of experiments that were
previously given LEC consent no. ……………………….. previously
□ Does not apply
7) FINANCING FROM THE PRO-QUALITY GRAND KNOW
Justification for financing:
(Demonstrate consistency with research topics included in the KNOW application form)
MEDICAL UNIVERSITY
OF BIAŁYSTOK
ul. Jana Kilińskiego 1, 15-089 Białystok
Tel. 85 748 54 15, fax 85 748 54 16
e-mail: cir.know@umb.edu.pl
Describe the planned efforts for obtaining other funds for scientific research.
(How will the proposed project contribute to the chances of obtaining financing from other sources?)
Describe the planned co-operation with other units participating in KNOW.
(Will other centers (including foreign ones) participate in the project?)
8) DIDACTIC AND RESEARCH TASK COST ESTIMATE
Content
Amount planned
Materials and reagents:
Subcontracted services:
PET/MRI Scans:
Local:
Business trips
Foreign:
Total cost:
…………………………….
Date
……………………..………..
Project Author's signature