Research Grant/Project Proposal Step 1 of 13 PART I Name of Grant * —Please choose an option—Sardar Bishnu Mani Acharya Research Grant for UG Students/Interns/MOs.Mrigendra-Samjhana Paediatrics Research Grant for PG Students/MOs/Junior PaediatriciansNEPAS Research Grant for Young Paediatric ResearchersNEPAS Child Health Research Grant for Practicing PaediatriciansNEPAS Research Grant for Paediatric Nurses NextStep 2 of 13 PART II : Details of Applicant Name of PI* Address of PI* Gender* MaleFemale Date of Birth* Mobile Number* Email* Affiliated Institution/Medical College/Hospital/Others Highest Academic Degrees* MBBSMDMNOther Year of Certification* Date of Council Registration of Minimum Qualification required NMC/NNC Number* NEPAS Membership Number Nodal Centre for Research* Sub Centre for Research Name and address of supervisor Name of Supervisor Address of Supervisor Supervisor's Affiliated Institution/Medical College/Hospital/Others Designation of Supervisor Signature of Supervisor Supervisor Mobile Number Supervisor E-Mail Supervisor NMC/NNC Number Supervisor NEPAS Membership Number Bank Detail of PI Bank Account Number of PI* Bank Name* Branch* PAN Number of PI* BackNextStep 3 of 13 PART III :Research Team Principal Investigator Principal Investigator Name* Principal Investigator Qualification* Principal Investigator Affiliation* Supervisor Supervisor Name Supervisor Qualification Supervisor Affiliation Co-Supervisor Co-Supervisor Name Co-Supervisor Qualification Co-Supervisor Affiliation Investigator Investigator Name Investigator Qualification Investigator Affiliation Investigator Name Investigator Qualification Investigator Affiliation Investigator Name Investigator Qualification Investigator Affiliation BackNextStep 4 of 13 Part IV: Project Summary Project Summary* Background Scope of Problem* Literature Review* Why This Study Needs to be Done?* Theoretical Basis* Long Term Uses of Research* Aim & Objectives* Outcome of the Study* BackNextStep 5 of 13 Part V : Methodology Study Design* Duration of the study* Study Population* Inclusion Criteria* Exclusion Criteria* Sampling Method & Size calculation* Details Of Subject Enrollment procedure* Data Collection Procedure &Tool* Training Procedure for Data Collector* Facility and Equipment Access* Procedures for Working with Hazardous Materials / Situations (if any) Registration of Clinical Trials in Registry (if any) BackNextStep 6 of 13 Part V(B) :Ethical Issues Informed Consent and Voluntary Participation* Confidentiality of the Subject* Involvement of Vulnerable group* Expected Risk and Benefits for the Subject* Plan for provision of coverage for medical risk (if any) Limitations* Provision for Dissemination of Research Result* BackNextStep 7 of 13 Part VI: References References* BackNextStep 8 of 13 Part VI: Timeline Activity Projected Date -+ BackNextStep 9 of 13 Part VIII: Budget Overview in Nepali Rupees (NRS) Description Price Quantity Total -+ BackNextStep 10 of 13 Part IX Statistical Consideration* Institutional Approval (IRB)* Conflict of Interest (if any) Participant Information Sheet (PIS) & Consent Form* Case Recod Form(CRF)* Upload doc, docx or pdf files, max size: 1 MB. BackNextStep 11 of 13 Part X: Other Information Other Information(if any) BackNextStep 12 of 13 Part XI: Signatures of Investigators Investigators Name Investigators Signature -+ BackNextStep 13 of 13 Part XII: Appendix Citizenship Certificate of PI* Upload png, jpg or pdf files, max size: 3 MB. CV of Applicant* Upload png, jpg or pdf files, max size: 3 MB. Declaration on Compliance to NEPAS Grant Guideline on Project Execution * Upload png, jpg or pdf files, max size: 3 MB. Statement of Originality of Research (except thesis)* Upload png, jpg or pdf files, max size: 3 MB. Letter from IRB/IRC (From Institution or NHRC)* Upload png, jpg or pdf files, max size: 3 MB. Clinical Trial Registry (if required) Upload png, jpg or pdf files, max size: 3 MB. Reference Letter from Organisation(In case of externally funded projects only) Upload png or jpg files, max size: 3 MB. Covering Letter from Head of the Nodal Centre for Research on Permission to use Institute for Sample Collection (if required) Upload png, jpg or pdf files, max size: 3 MB. Note: Please note that details about authors or institutions should be mentioned in the main proposal. The proposals will be disqualified if such details are not found, or if there are no signatures in the undertaking. All information must be true and correct, failure to do so may disqualify the application or the grant itself.Back
