Please TICK (√) the applicable boxes.
Type of submission New submission Resubmission
Type of Research Project
Industrial Sponsored Research (ISR)
Investigator Initiated Research (IIR)
Investigator Initiated Sponsored Research (IISR)
A. PRINCIPAL INVESTIGATOR INFORMATION Name
(Full name with Title)
Mykad /
Passport No Staff No
Designation Appointment
Date K/C/D/I/O
(Full address)
Office No Mobile No
Email Address
B. CO RESEARCHER(S) INFORMATION
Other researchers involved in the project (including post-graduate):
No
. Name Staff No/Mykad/
Passport/ Matric No K/C/D/I/O Role in
Research Mobile No
C. RESEARCH PROJECT INFORMATION
Research Title
Research Duration
D. EXECUTIVE SUMMARY
(Provide a summary of the proposed research project in not more than 300 words)
Keywords
(Please provide a maximum of 5 keywords that describe the nature of the research project)
1. Research background including hypothesis /research questions and literature review
2. Research objective(s)
3. Research methodology
a. Description of methodology (Study Design, Sampling design, Data Collection, Sampling size) b. Flowchart of research
4. Expected Results
5. Expected impact on community / clinical aspect (including impact to SASMEC, if applicable)
F. PROJECT SCHEDULE
Please list major activities involved in the proposed project and attached the Gantt chart.
G. BUDGET ALLOCATION (if applicable) Name of Sponsor/ Grant Provider Type of Sponsorship/ Grant Awarded
Total Amount Budget Detail
(Please attached the budget detail, if possible)
H. DECLARATION BY APPLICANT
I hereby declare: All information stated herein is true.
_____________________
Signature and stamp: ___________________________ Date:
I. RECOMMENDATION OF THE DEPARTMENT
(Head of Department/ Head of Research / Deputy Dean Postgraduate and Research/ Dean)
Recommended Not Recommended
Remarks (if any): ___________________________________________________________________
___________________________________________________________________
Signature and stamp: ________________________ Date: __________________________
J. VERIFICATION BY DEPARTMENT OF EDUCATION AND RESEARCH Checked by:
Signature and Stamp:
Date:
Verified by:
Remarks (if any): _______________________________________
_______________________________________
_______________________________________
Signature and Stamp:
Date:
K. DECISION BY SASMEC RESEARCH COMMITTEE (SASRC)
Approved Not Approved
Remarks (if any): ___________________________________________________________________
___________________________________________________________________
Signature and stamp: _____________________________ Date: __________________________
