SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM APPLICATION FOR EXTENSION OF RESEARCH PROJECT
This form must be submitted to the Clinical Research Centre, Level 4, Sultan Ahmad Shah Medical Centre @IIUM, Kuantan, PahangA. PROJECT INFORMATION
Type of Grant SASMEC Research Grant (RM 20,000)
Awarded Date Expected Completion Date
Principal Investigator
NRIC / Passport No Staff No
Office No Mobile No
Email Address K/C/D/I/O
Project ID Project Title
B. PROJECT EXTENSION DETAIL - Maximum duration of extension allowable is 1 Year from the expected date of completion
New Completion Date Justification
(Please attach the progress report and new milestone)
Signature and Stamp Date of Request
C. RECOMMENDATION OF THE DEPARTMENT
Sultan Ahmad Shah Medical Centre @IIUM, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur.
Tel: 09-591 2500
SASMEC-DEAR-CRC(SG)-F012 VER: 01 REV: 01 EFFECTIVE DATE: 03 OCTOBER 2022
SULTAN AHMAD SHAH MEDICAL CENTRE @IIUM APPLICATION FOR EXTENSION OF RESEARCH PROJECT
(Head of Department/ Head of Research / Deputy Dean Postgraduate and Research/ Dean) Recommended Not RecommendedRemark (if any): __________________________________________________________________________
__________________________________________________________________________
Signature : ____________________________ Date : _______________________
Stamp :
D. DEPARTMENT OF EDUCATION AND RESEARCH Verified by:
Signature & Stamp:
Date:
Approved by:
Approved : Not Approved:
Remarks :
Signature & Stamp:
Date:
Sultan Ahmad Shah Medical Centre @IIUM, Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur.
Tel: 09-591 2500
SASMEC-DEAR-CRC(SG)-F012 VER: 01 REV: 01 EFFECTIVE DATE: 03 OCTOBER 2022
