New research proposal form


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New research proposal form

  1. 1. KING ABDULLAH INTERNATIONAL MEDICAL RESEARCH CENTERKING SAUD BIN ABDULAZIZ UNIVERSITY FOR HEALTH SCIENCESNational Guard Health AffairsFOR OFFICIAL USE ONLYDate of Receipt Research Area ID Number1. Title of Proposal: (Instructions: fill all appropriate boxes applicable to your project)2. Type of project (please check all applicable options)Chart Review Diagnostic PhD Project Qualitative ResearchHuman Laboratory MSC Project Quantitative ResearchTherapeutic Basic Science Other: _____________________3. Starting Date: 4. Duration: 5. Total Fund Requested (SR):6. Principal Investigator (PI):Name: Tel. No. (W): Mobile No.:Affiliation & Address:Title/Position: Email:7. Name of co-investigator (PI) (instructions: There is no limit to the number of co-investigators and theirexpertise should cover the different areas)Co-Investigators Title/Position Department Signature8. Principal Investigators Assurance:The undersigned agrees to accept responsibility for the scientific and technicalconduct of the proposed research and submission of progress reports if thisapplication is approvedSignature of the Principal Investigator DateAPPROVEDName and Signature of the Chairman Department
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  3. 3. 9. Background: (Instructions: Literature review of previous studies on the subject; and justification of thestudy by stating the problem and its public health importance)3
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  5. 5. 10. Objectives of the study:10.1 Aim of the study: (Instructions: state the goal you need to achieve)10.2 Specific objectives: (Instructions: state the details of each objective that will finally lead toachievement of the goal) Secondary objectives: (Instructions: these are subsidiary objectives that could be studied during thecourse of the project but are not the main objectives of the study, they are optional and vary according to thetype of the study)5
  6. 6. 11. Materials and Methods: (Instructions: Describe the research methods that could best achieve the studyobjectives, recommend to attached flow charts)11.1 Study Area/Setting: (Instructions: describe the area or setting where the study will be conducted. Thisdescription should cover the details relevant to the study topic)11.2 Study Subjects: (Instructions: Inclusion and exclusion criteria of the study subjects)6
  7. 7. 11.3 Study Design: (Instructions: mention the type of study design eg cross-sectional, case-control,intervention study, etc..)11.4 Sample Size:: (Instructions: mentioned the input criteria for smple size estimation.)7
  8. 8. 11.5 Sampling Technique: (Instructions: mention the sampling technique, (e.g. randomization) that will beused on order to obtain a representative sample for your target population.)8
  9. 9. 11.6 Data Collection methods, instruments used, measurements(Instructions: Describe the instruments used for data collection (questionaire, observation recording from,ect..), ans studied variables included in these instruments, as well as the methods used to testfor the validity and reliability of the instrument. Techniques used should be briefly describedand referenced. Study definitions (eg case definition) should be mentioned)9
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  11. 11. 11.7 Data mangement and analysis plan:(Instruction: Describe the analysis plan, tests used for data analysis ans statistical package(s) used)12 Bibliographic References: (Instructions: mention recent articles relevant to the study subject andenumerated accroding to their order of appearance in the text)11
  12. 12. 15 workplan: (Instructions: Please use this form as a template for the timeline of your project)Task MONTH1 2 3 4 5 6 7 8 9 10 11 12Progress report12
  13. 13. • Funds allocated to all personnel should not exceed 30% of the budget,otherwise justification letter should be included• Unit cost of each task should be accurately given to allow propoer budgetevaluation.16. Budget (Please use the attached documents for the price list of equipments used in the project ifapplicable)Budget Breakdown Unit cost(SR)Total(SR) RemarksPersonnel *TotalSupplies and EquipmentPatients CostTotalTrainingTotalOthers (please, specify and justify briefly)TotalGRAND TOTAL13
  14. 14. 17. Appendices: (Instructions: Data collection instruments, elaboration on methods and procedures to be used,etc..) (Please attach the related documents)14
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