Download (iltc) research grant - Agency for Integrated Care

AIC ILTC Research Grant Application
AIC INTERMEDIATE AND LONG TERM
CARE (ILTC) RESEARCH GRANT
Application Form
IMPORTANT: EVERY SECTION AND FIELD MUST BE COMPLETED. PLEASE
INDICATE ‘NA’ WHERE A PARTICULAR SECTION OR FIELD IS NOT
APPLICABLE. INCOMPLETE APPLICATIONS WILL BE REJECTED.
All sections of this Application Form must be completed. Incomplete applications will be
rejected without review.
Applications must be submitted to Mr Yeo Guan Teck at [email protected] with the
subject heading: The Intermediate and Long-Term Care (ILTC) Research Grant Call
Submission <Name of Lead PI’s Institution>
Softcopy submission must comprise of the Pre-Proposal in BOTH the following formats:
a. Word document (without signatures), as well as
b. Scanned hardcopy (complete with Lead-PI’s signature and Host Institutions’
signatures) in PDF format and in colour.
The deadline for softcopy submission is 3 Aug 2017 (Thursday) at 5 pm (local time).
Original hardcopy submissions are NOT required, but to be retained and kept by
respective teams.
For further enquiries, please contact Mr. Yeo Guan Teck at [email protected]
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AIC ILTC Research Grant Application
Information is furnished to the Agency for Integrated Care with the understanding
that it shall be used or disclosed for evaluation, reference and reporting
purposes.
SECTION 1
Proposal Title
Budget Requested
Period
years)
of
Support
(in Host Institution
I. Provide answers to the following:
1. Have you attended any briefing on the Human Biomedical Research Act,
either organized by AIC or by your institution?
 Yes. State the date of the briefing that you attended: _________________
 No
2. I am aware of my obligations as a researcher under the Human Biomedical
Research Act.
 Yes
 No
3. Research being proposed in this submission is within the scope of Human
Biomedical Research as defined by the Human Biomedical Research Act
 Yes (please answer question 4.)
 No (please skip question 4)
4. I have identified a Research Institution (as defined by the Human Biomedical
Act) which will provide supervision for this research project, if I am awarded the
grant.
 Yes. State the name of the Research Institution that will supervise this
research:
_________________________________________
 No; I am still trying to identify a Research Institution that will supervise this
research
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AIC ILTC Research Grant Application
I am applying for:
 New Investigator Grant (At least one mentor must be included in the list of
investigators)
 General Grant
Role
Name
Designation
Department
Institution
Lead PI
Co-PI(1)
Co-PI(2)
Co-PI(3)
Collaborator
Collaborator
Mentor
(If applicable)
Mentor
(If applicable)
SECTION 2
SCIENTIFIC ABSTRACT OF THE PROPOSAL
In no more than 300 words, provide a succinct and accurate scientific description of the
proposal to include the specific aims, hypotheses, methodology and approach of the
research proposal. Note that the scientific abstract may be disclosed.
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AIC ILTC Research Grant Application
LAY ABSTRACT OF THE PROPOSAL
In no more than 300 words, provide a succinct and accurate lay description of the
proposal to include the specific aims, approach and significance of the research
proposal, including its importance to science or medicine. Note that the lay abstract
may be disclosed.
Potential Application/Impact of the outcomes
In no more than 100 words, state the potential application and/or impact, stating
relevance to AIC or the ILTC sector.
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AIC ILTC Research Grant Application
SECTION 3
Research Objectives
Describe your research question/s. Provide a brief literature review of the problem - what
has been done to date, what is known about the subject, and what are the areas of
uncertainty or active research. How do your research questions address these areas?
What is the significance of your research questions?
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AIC ILTC Research Grant Application
Research design (Do not exceed 5 pages)
What is your proposed study design? Why do you think this design will be successful?
Give as much details as possible. Show that your study design will be able to answer
your research questions.
Programme Plan (Do not exceed 5 pages)
How do you plan to organize the financial and human resources to complete the
research? Outline the schedule for all phases of the proposed project – a Gantt chart
can be attached as an Annex.
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AIC ILTC Research Grant Application
Role of Team Members
What are the roles and contributions of Co-PI and collaborators? Why are you and your
team members particularly qualified to do this? How do the collaborations between the
disciplines, institution or with industry add value to the project? Briefly describe the
plans for interaction among the team member(s) and with collaborators in achieving the
research objectives.
Role of Mentor (Please complete this section only if you are submitting under the
New Investigator Grant)
Describe how your mentor will help you in completing this research project and
achieving the outcomes and indicators set.
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AIC ILTC Research Grant Application
Outcomes & Deliverables /Key Performance Indicators
Propose 2 or more outcomes and Key Performance Indicators for your project.
Indicate how this proposal could generate value for Singapore or the ILTC sector, or
provide benefits to Singaporeans.
SECTION 4
Provide an estimated budget and a brief narrative in the “Description” column.
Budget
Category
Expenditure
on Manpower
(EOM)
Description
Proposed Budget
Expenditure
on Equipment
What equipment and supplies are required to
succeed? Explain why existing infrastructure is
unsuitable or unavailable where new purchases
are proposed.
What are the types, amounts, and costs of labour
required for this program? Link the labour
allocations to the proposed technical milestones.
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AIC ILTC Research Grant Application
Other
Operating
Expenses
(OOE)
What is the expected unit cost per headcount per
year?
TOTAL
Have you obtained other sources of research funding, or are you planning to apply for
other sources of research funding for this project? Please indicate the source and
quantum obtained or applied for, and the components of the research to be covered by
the quantum. Indicate the status of any application.
Please indicate any other in-kind contribution, including manpower, services,
consumables or supplies that will be provided for the project. Indicate the source of the
contribution.
SECTION 5
Curriculum Vitae of all members in this research study (principal investigators,
co-investigators, collaborators and mentors)
Use this format:
 Name
 Title
 Office Mailing Address
 Email/contact number
 Current position (to include primary, joint and other academic appointments
 Academic Qualifications
 Not more than 5 most important publications in the last 5 years that pertains to
the proposed project
 Patents filed (related or unrelated to the proposed project)
 Professional awards
 Half page summary of the most relevant research outcomes from all previous
grants
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AIC ILTC Research Grant Application
SECTION 6
UNDERTAKING BY PRINCIPAL INVESTIGATOR AND ALL CO-PRINCIPAL
INVESTIGATORS
In signing the Grant Application, the Principal Investigator and all Co-PI(s)
UNDERTAKE, on any Grant Award, to:
 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) for studies involving human subjects.
 Be actively engaged in the execution of the research and comply with all laws,
rules and regulations pertaining to human ethics, including the Singapore
Good Clinical Practice guidelines.
 Ensure that AIC’s funding is acknowledged in all publications.
 Ensure that all publications arising from research wholly or partly funded by
AIC will be forwarded to AIC.
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AIC ILTC Research Grant Application
-----------------------------------------------------Name and Signature of Principal Investigator
Date:
----------------------------------------------Name and Signature of Co- Investigator
Date:
----------------------------------------------Name and Signature of Co- Investigator
Date:
----------------------------------------------Name and Signature of Collaborator
Date:
----------------------------------------------Name and Signature of Collaborator
Date:
----------------------------------------------Name and Signature of Collaborator
Date:
----------------------------------------------Name and Signature of Collaborator
Date:
----------------------------------------------Name and Signature of Mentor
Date:
----------------------------------------------Name and Signature of Mentor
Date:
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AIC ILTC Research Grant Application
SECTION 7
UNDERTAKING BY THE HOST INSTITUTION
In signing the Grant Application, the Host Institution UNDERTAKES, on any Grant
Award, to:
 Provide appropriate support during the grant period.
 Ensure that the funds provided are used for the appropriate purposes.
 Ensure that the study complies with all laws, rules and regulations pertaining to
animal and human ethics, including the Singapore Good Clinical Practice
guidelines.
 Have in place code of practice for research integrity and procedures to deal with
unethical research practices.
-----------------------------------------------------Name and Signature of Director of Host Institution*
Date
* If the Principal Investigator is the Director of the Institution, UNDERTAKING by the
Director’s Reporting officer is required.
-----------------------------------------------------Name, Designation and Signature
Date
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