Lien Centre for Palliative Care Grant Application Form

July 2011, Version 1

  1. Title of Project
  1. AMOUNT OF FUNDING REQUESTED FOR: S$ ______
  1. START DATE OF PROJECT(dd/mm/yy): ______
  1. END DATE OF PROJECT(dd/mm/yy): ______
  1. PRINCIPAL INVESTIGATOR

Please note that only one Principal Investigator per application is allowed.

Any local clinician, allied health worker, or researcher in palliative care is eligible to be the Principal Investigator of the project.

Full Name (underline surname):

Position:

Primary institution / Department:

Email:

Contact number:

  1. CO-INVESTIGATOR (S) / COLLABORATOR(S)

Please expand the list accordingly based on the strength of the research team.

Full Name (underline surname):

Position:

Primary institution / Department:

Email:

Contact number:

  1. Declaration of Ethics Consideration

Please note that fund reimbursement is subjected to ethics approval once project has been approved.

Ethics Approval status: Not applied yet / Pending approval / Approved*

(*Delete as appropriate)

If Ethics Approval has been granted, please indicate approving institution and approval code below: ______

  1. Abstract of the Proposal

In no more than 300 words (Arial font size 11, single spacing), please provide a succinct and accurate description of the proposal to include specific aims, hypotheses, methodology and how the research can impactpalliative careinSingapore.

  1. Details of Research Proposals

Give a description of the research in no more than 4 pages (Arial font size 11, single spacing), including any figures or tables. Information should include objective(s) of the project, background and rationale, experimental design and methods, relevance of proposed research to palliative care concerns in Singapore and/or Southeast Asia. There should be no more than 40 references cited and they should be provided at the end of this section; this does not count towards the 4-page limit.

  1. BIOGRAPHICAL SKETCH OF PRINCIPAL INVESTIGATOR, CO-INVESTIGATOR(S) AND/OR COLLABORATOR(S)

In not more than 2 pages, provide biographical sketches of the Principal Investigator, Co-Investigator(s) and/or Collaborator(s) using the template below. The biographical sketch must include all other support of the Principal Investigator including those from institutional sources

BIOGRAPHICAL SKETCH

Provide the following information for the Principal Investigator/ Co-Investigator / Collaborator* of this project. DO NOT EXCEED TWO PAGES. (*delete accordingly)
NAME / POSITION TITLE
CITIZENSHIP
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)
INSTITUTION AND LOCATION / DEGREE
(if applicable) / YEAR(s) / FIELD OF STUDY
  1. Positions and Honors. List in chronological order previous positions, concluding with your present position. List any honors.
  1. Selected peer-reviewed publications (in chronological order). Do not include publications in preparation.
  1. Research Support. Listongoing or research projects (competitive and institutional support). Begin with the projects that are most relevant to the research proposed in this application. Briefly indicate the overall goals of the projects and your role (e.g. PI, Co-Investigator) in the research project. List total award amounts for each.
  1. PROPOSED BUDGET

Please use the format below and reattach the completed version within this document:

  1. JUSTIFICATION FORPROPOSED BUDGET

Please provide justification for all categories of the proposed budget (ie EOM, Equipment and OOE)

  1. Undertaking by Principal Investigator

In submitting the proposal, the Principal Investigator undertakes, on any Grant Award, to:

-Declare that all information is accurate and true

-Submit supporting documents of ethics approval obtained from the relevant Institutional Review Board (IRB) for studies involving human subjects prior to initiation of the studies

-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

Please tick accordingly

I accept the above undertaking
I do not accept the above undertaking

______

Signature of Principal Investigator Date

  1. Endorsement by Principal Investigator’s Head of Department / Institution Head*

(*If Principal Investigator is Head of Department, the endorsement will have to be done by the Institution Head. Please delete accordingly)

______

Name of Head of Department / Institution Head*

(*delete accordingly)

______

Signature of Head of Department / Institution Head*

(*delete accordingly)

NOTE:

  1. Review Process: Proposals will be reviewed by theScientific Advisory Board and the Grant Review Committee, both which are appointed by the Lien Centre for Palliative Care, Duke-NUS Graduate Medical School.
  1. Review Criteria: Proposals will be scored based on the following criteria:

(i)Scientific Merit – What is the scientific merit and feasibility of the proposed studies? How appropriate is the experimental design for achieving the stated objectives?

(ii)Innovativeness – Does the proposed research move the P.I.’s program in new directions? To what extent does the proposed research foster the application of new technologies and new experimental approaches?

(iii)Investigator – What are the qualifications of the P.I. for carrying out the proposed research? Is this a new direction for the applicant?

(iv)Relevance and Potential Impact – What is the relevance of the proposed research to medical concerns of Singapore and/or Southeast Asia? What is the likelihood that the results obtained will lead to future external funding of a larger project on this topic?

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