Name*

First NameLast Name

Academic Title*

Highest Academic Degree Obtained*

Date Obtained*

Institutional Affiliation*

MaleFemale

Date of Birth

Date

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name*

First NameLast Name

Highest Degree Obtained*

Date Obtained*

Institutional Affiliation

MaleFemale

Date of Birth

Date

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Description of Previous Research Experiences of the PI and Co-PI*

Please list

Title *

Proposed duration (9-15 months maximum)*

Enter Text Here*

Describe Research Gap*

List Specific Objectives*

Study design for each objective*

Which groups will be recruited and list inclusion and exclusion criteria*

Describe the methods to recruit the study participants*

Calculate the sample size

Describe how you will analyze the data.*

Describe the significance of the research*

YesNo

Yes, obtained approvalNo, but submittedNo, we will submit if funded

YesNo

If no, please explain why

Describe methods to ensure the confidentiality of the data*

YesNo

If yes, please describe safeguards to provide additional protections

Please describe who will obtain informed consent and describe the informed consent process

Please list at least 10 recent articles relevant to the study subject

Budget Items

Rows	Amount Requested	Justification
Personal
Materials and Supplies
Equipment
Recruitment Activities
Travel Expenses
Training
Costs

Total Amount Requested in US dollars*

Not to exceed $5000; salaries of investigator and co-investigator should not exceed 25% of the total budget; salaries of all personnel should not exceed 60% of the budget

Instructions for budget items:

1. Personnel

Justification should be provided if there is an intent to fund a portion of PI or co-PI salaries. Personnel costs include compensation for data collectors, field workers, lab technicians, data managers, etc.

2. Material and Supplies

The budget must indicate the general types of expendable materials and supplies required, with their estimated costs. The breakdown should be more detailed when the cost is substantial.

3. Equipment

This grant does not support general purpose equipment, such as a personal computers, telephone sets, photocopying / facsimile machines etc.

4. Human Participants

The needs for requiring direct compensation of participants must be fully justified (e.g. transportation, compensation for time, etc.)

5. Travel

Travel and its relation to the proposed activities must be specified and itemized by transportation costs, hotels, etc.

6. Training

Funds can be allocated to train personnel on the grant, e.g., field workers, data collectors, etc.

7. Other Costs

The budget must identify and itemize other anticipated costs not included under the headings above. Examples include telecommunications and photocopying. Reference books, periodicals and other scientific literature may be charged to the Grant only if they are specifically required for the project.

File Upload*

Appendicies

Please provide as PDF files the following documents

Data Collection Forms (e.g., questionnaires, interview guides, etc.
Informed Consent Forms (in English)
Ethics Approval from all participating Institutions
CVs of PI and co-PI

File Upload

Application Attestation

I Agree

Grant Application

Principal Investigator

Co-Principal Investigator

List other members of the research team with their highest degrees

Grant Proposal

Background (1-2 pages)

Research Gap

Specific Objectives

Methods to Address Each Objective

Study Participants

Recruitment Process

Sample Size

Statistical Analysis Plan

Significance of the Research

Ethical Considerations

Informed Consent Process

Bibliographic References

Budget

Instructions for budget items:

Study Time Frame

Appendicies

Please provide as PDF files the following documents

Application Attestation