Address:
UMCG
Sector F
Junior Scientific Masterclass
Huispostcode FC40
P.O. Box 196
9700 AD Groningen
T (050) 3616826
/ Application form
Pilot Project (6 ECTS)
Basic information

1a. Student

First name, last name, initials:
Male/ female:
Place and Date of birth:
Nationality:
Telephone number
E-mail address (only use your …@student.rug.nl):
Student number:

1b.Principle Investigator (PI):

Title, first name, last name, initials:
Department:
Member of GSMS (Yes/ No)
Principle investigator1 (Yes/ No):
Research institute2:
E-mail address:

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 research institutes of the UMCG’s Graduate School Medical Sciences.

2GUIDE, BCN, SHARE, CRCG or Kolff Institute

1c. Other research supervisors (max. 2)

Title, first name, last name, initials:
Department:
Member of GSMS (Yes/ No)
Principle investigator (Yes/ No):
Research institute1:
E-mail address:

1GUIDE, BCN, SHARE, CRCG or Kolff Institute

Title, first name, last name, initials:
Department:
Member of GSMS (Yes/ No)
Principle investigator (Yes/ No):
Research institute1:
E-mail address:

1 GUIDE, BCN, SHARE, CRCG or Kolff Institute

1d. Site of research (department where the student will be stationed)

Department:
Mailing address:
Huispostcode:
Supervision plan

2a.Description of the supervision, including the role of all involved supervisors

(Maximum 150 words. Please describe the supervisionplan including technical support by analists/ bioinformatics if relevant. Give a statement that all supervisors agree on the content of the pilot project)

2b.Distribution teaching hours over the (Y)PIs (max. 30 hrs in total, max. 3 (Y)PIs)

Name(Y)PI / Teaching hours
Summary

3a.Title of research proposal:

3b.Summary of research proposal (max. 300 words):

3c.Research period:

Research project takes place fromto (dd-mm-yyyy)

3d.Project code number(The Project code number (kostenplaatsnummer) to which the (partial) compensation for the research costs can be remitted after approval by the JSM of the student’s final report of the project)

3e. Is this research proposal a revised version? (Yes/ no)

3e. Is this research proposal a continuation of an earlier awarded pilot project? (Yes/ no) (This also can be a pilot project done by another student. Please report which project that was including the student’s name if relevant)

Research proposal (add tables/figures as appendices)

4a.Introduction(Maximum 300 words. The Introduction section should comprise a short description of the scientific background of the proposed research including a problem definition)

4b. Hypothesis(Maximum 200 words)

4c.Primary research question(Maximum 1 sentence ending with a question mark)

4d.Secondary research question(s)(If applicable, formulated as questions)

4e.Methods(Maximum 700 words. Include the study design, research subjects (e.g. patients/animals/cell lines), the comparison made, the primary and secondary outcomes, power analysis and an overview of the data to be collected, and, if relevant, a statistical plan):

4f.Time planning(The time planning should clearly describe the activities that the student will be doing him/herself as part of the research project including when the student will perform these and the amount of hours it will take. The minimum time investment will be 6 ECTS, but more is accepted as well, especially if it contributes to the student’s research training)

4g. Licences and registrations needed for the execution of the pilot project(Local Medical Ethical Committee (METc), Local Committee for Experiments on Animals (DEC), UMCG Research register, other.Without approval the project cannot be awarded. When not yet awarded, give an estimated date as to when the licence is expected to be active so that a starting date for the pilot project can be estimated

Licence type* / Approval (yes/ no) / Registration nr

*Please send a copy of the approval with this application

4h.References(max. 10, Vancouver style)

4i.Budget(This section should outline the costs of the research, for example costs for antibodies used in lab tests or other bench fees)

Study details

5a.BSc degree programme:

Degree programme (Medicine/IBMG/Dentistry)
Learning Community:
Start date:
(Expected) bachelor graduation date:
2nd or 3rd year:

5b. If applicable:Title, supervisor, department and research period of the Bachelor project(a pilot project may not, in any part, overlap with the Bachelor project)

5c.Other courses/activities/degree programmes(courses/activities within or outside the JSM programme and/or other Bachelor’s or Master’s degree programmes)

5d.Research experience:

Signatures

6a. Student:

Name:
Date:
Signature:

6b. Principle Investigator:

Name:
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) 3616826

e-mail:

website:

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