Application Form for Doctorate Research Grant
Total Page：16
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FORM 1A – page 1
APPLICATION FORM FOR DOCTORATE RESEARCH GRANT
1 FORM 1A – page 2 APPLICATION FORM FOR DOCTORATE RESEARCH GRANT
Title of Research
Scope of research 1. Nutrigenomic 2. Dietetic and Clinical nutrition 3. Community and Public Health nutrition 4. Food Security and Policy Name of student (PI)
Academic degree/ title (university)
Name of current institution (where you are studying)
Name of faculty
Name of department
Name of home institution (please indicate department & faculty) Address of Home Institution
Name of advisor(s)
Name of institution of advisor
Address of institution of advisor
Contact address of PI Telephone
Fax
Mobile
Mail address
Research Title
Propose starting date of research (dd/mm/yy)
Propose end date of research (dd/mm/yy)
Total grant requested (in Rp)
Date of application
Reason for applying
2 [TITLE OF THE PROPOSAL]
[SUMMARY OF THE PROPOSAL]
3 FORM 1A – page 3 APPLICATION FORM FOR DOCTORATE RESEARCH GRANT
Research Location Name of city or village
Name of sub-district
Name of district
Province Place (eg Laboratorium, green house, hospital) Type of research (circle one) 1. Survey 2. Experimental 3. Laboratorium work 4. Others, specify ...... If this study is part of a bigger research, please mention the name Ethical clearance (circle one) 1. Available, name of institution ……………………… 2. In the process, date submitted & name of institution …………………………………………………….... 3. Not yet processed Field permit (circle one) 1. Available, name of institution ……………………… 2. In the process, date submitted ……………………… 3. Not yet processed Number of planned result dissemination & publication: Seminar/conference
International journal – obligatory (including name of journal)
Local journal – optional (including name of journal) Expected output, please elaborate on these aspects: 1. Enhancement of the researcher’s capacity 2. Promotion of scientific research findings recognized by local and international scientific communities 3. Strengthening education and research capacity of the institution 4. Development of scientific community network in the field of nutrition and health 5. Contribute evidence-based recommendations for policy decision 6. Link to current global concern, e.g. Millennium Development Goals (MDGs), Scaling Up Nutrition (SUN), prevention of stunting, prevention of Non- Communicable Diseases (NCDs)
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