Major Impact Project (MIP)

General Information
Full Name*

First NameLast NameTitle
Race*
Gender*
Citizenship*
South African Citizen?
Other*
Please provide details
Present Institution*
Work Address
Full Postal Address
Contact Number
Please enter a valid phone number.
Email*

Confirmation Emaila valid email
Institution Name*
For Relevant Grant Cheque
Banking Details Of Relevant Institution*
Current Qualifications*
List your qualifications
Present Professional Status
Are You An Early Career Scientist?*
less than 10 years from PhD
Relevant Work Experience To Date

Relevant Work Experience To Date

	Name Of Employer/Institution	Capacity And Type Of Work	Period
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5.

Project Information
This section should include information relating to:
- The Purpose of the research
- The importance of the research
- The background and feasibility of the project
- A brief description of relevant information, the target population, hypotheses, and methodology
- A brief description of methodology and expected results
- A description of the contributions your research will make to the field of knowledge and health outcomes
Title Of Project
Title Of Project*
Short Project Description
Short Project Description*

(Scientific abstract of project - 1500 characters max)0/1500
Scope Of The Project For Which A Grant Is Requested (Proposed Research Programme And Plan Of Approach)
A brief review of published literature (max 20 references)

As a general rule, citations older than 10 years should not be used unless they are absolutely necessary in making the case for the proposed study or, if they are seminal works that should not be omitted.
Project Background and Rationale*
Specific Objectives*
Please List Objectives in the block
Preliminary Data*
If non available, please indicate 'No Preliminary Data'
Research Plan And Methodology*
Timelines*
Indicate project tasks and timelines for completing each
Details Of Research Team
Note: Please attach a SHORT CV of the supervisor and Senior Members of the Research Team at the bottom of this application

Details Of Research Team

	Name	Qualifications	Role	Time Devoted To Program
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Capacity Building

What Capacity Building Will Derive From This Project (Student(s) Info)

	Name	Degree	Funding Body
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PRF Bursary Application Linked To This Application (Student(s) Info)

	Name	Degree
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Budget Details

Budget Details (Please ensure that unit costs and number of units are specified)

	Consumable Materials	Number Of Units	Unit Cost	Year 1	Year 2	Year 3
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5.

Total Budget (Year 1 / 2 and 3)

Other (Specify)

	Description	Qty	Price Per Unit	Total
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Total for Other
Capital Equipment

Items expected to last longer than three years

	Description	Cost(VAT Inclusive)
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Total for Capital Equipment
Motivation For Purchase Of Equipment
Budget Summary

Budget Summary (Please list Consumables, Other and Capital Equipment under "Type")

	Type	1st Year	2nd Year	3rd Year
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2.
3.
4.
5.

Declaration Of Research Funding
Is This Your First Application To The PRF For A Grant?
Please Supply Details

Details of all other research funding received at present

	Name Of Organisation	Project Title(Short)	Amount	Duration	Role In Project	Time Spent On Project
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2.
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5.

Does this present application overlap/partial overlap any of your funding received?
Justify overlapping*
NB: Any omission or misrepresentation in this section could jeopardize this and future funding

Apart from your university/institution, are any other institutions concerned with the provision of facilities (which may include clinical material) neccessary for this research project? If yes, complete the table below

	Name of University/Institution	Facilities required/provided
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Ethics Committee Certificate
NB: Your application will not be considered unless relevant ethics approval has been accepted.

Choose between Human And Animal for their relevant dropdown fields.
Human
Please Provide Human Ethics Certification (PDF)

Max file size: 600KB
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Please Provide Huma Ethics Certification (PDF)

Max file size: 600KB
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Animal
Please Provide Animal Ethics Certification (PDF)

Max file size: 600KB
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Checklist: Please Complete / Attach
Upload Your Supervisor CV

Max file size: 600KB
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Upload CVs (Including Publications)

Max file size: 600KB
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Quotes For Equipment

Max file size: 600KB
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Grants Application Signatory Form

Max file size: 600KB
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Any Other Additional Information You Wish To Present, If Graphs, Please upload the graphs in a PDF doc as an annex

Max file size: 600KB
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Should be Empty:

General Information

Relevant Work Experience To Date

Project Information

Title Of Project

Short Project Description

Scope Of The Project For Which A Grant Is Requested (Proposed Research Programme And Plan Of Approach)

Details Of Research Team

Capacity Building

Budget Details

Capital Equipment

Budget Summary

Declaration Of Research Funding

Ethics Committee Certificate

Checklist: Please Complete / Attach