AIC ILTC Research Grant Application

AIC INTERMEDIATE AND LONG TERM CARE (ILTC) RESEARCH GRANT

Application Form

IMPORTANT: EVERY SECTION AND FIELD MUST BE COMPLETED. PLEASE INDICATE ‘NA’ WHERE A PARTICULAR SECTION OR FIELD IS NOT APPLICABLE. INCOMPLETE APPLICATIONS WILL BE REJECTED.

All sections of this Application Form must be completed. Incomplete applications will be rejected without review.

Applications must be submitted to Mr Yeo Guan Teck at iltcresearch@aic.sg with the subject heading: The Intermediate and Long-Term Care (ILTC) Research Grant Call Submission <Name of Lead PI’s Institution>

Softcopy submission must comprise of the Pre-Proposal in BOTH the following formats:a. Word document (without signatures), as well asb. Scanned hardcopy (complete with Lead-PI’s signature and Host Institutions’

signatures) in PDF format and in colour.

The deadline for softcopy submission is 3 Aug 2017 (Thursday) at 5 pm (local time).

Original hardcopy submissions are NOT required, but to be retained and kept by respective teams.

For further enquiries, please contact Mr. Yeo Guan Teck at iltcresearch@aic.sg

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AIC ILTC Research Grant Application

Information is furnished to the Agency for Integrated Care with the understanding that it shall be used or disclosed for evaluation, reference and reporting purposes.

SECTION 1

Proposal Title

Budget Requested Period of Support (in years)

Host Institution

I. Provide answers to the following:

1. Have you attended any briefing on the Human Biomedical Research Act, either organized by AIC or by your institution?

Yes. State the date of the briefing that you attended: _________________ No

2. I am aware of my obligations as a researcher under the Human Biomedical Research Act.

Yes No

3. Research being proposed in this submission is within the scope of Human Biomedical Research as defined by the Human Biomedical Research Act

Yes (please answer question 4.) No (please skip question 4)

4. I have identified a Research Institution (as defined by the Human Biomedical Act) which will provide supervision for this research project, if I am awarded the grant.

Yes. State the name of the Research Institution that will supervise this research: _________________________________________

No; I am still trying to identify a Research Institution that will supervise this research

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AIC ILTC Research Grant Application

I am applying for:

New Investigator Grant (At least one mentor must be included in the list of investigators)

General Grant

Role Name Designation Department Institution

Lead PI

Co-PI(1)

Co-PI(2)

Co-PI(3)

Collaborator

Collaborator

Mentor(If applicable)Mentor(If applicable)

SECTION 2

SCIENTIFIC ABSTRACT OF THE PROPOSALIn no more than 300 words, provide a succinct and accurate scientific description of the proposal to include the specific aims, hypotheses, methodology and approach of the research proposal. Note that the scientific abstract may be disclosed.

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AIC ILTC Research Grant Application

LAY ABSTRACT OF THE PROPOSALIn no more than 300 words, provide a succinct and accurate lay description of the proposal to include the specific aims, approach and significance of the research proposal, including its importance to science or medicine. Note that the lay abstract may be disclosed.

Potential Application/Impact of the outcomesIn no more than 100 words, state the potential application and/or impact, stating relevance to AIC or the ILTC sector.

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AIC ILTC Research Grant Application

SECTION 3

Research ObjectivesDescribe your research question/s. Provide a brief literature review of the problem - what has been done to date, what is known about the subject, and what are the areas of uncertainty or active research. How do your research questions address these areas? What is the significance of your research questions?

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AIC ILTC Research Grant Application

Research design (Do not exceed 5 pages)What is your proposed study design? Why do you think this design will be successful? Give as much details as possible. Show that your study design will be able to answer your research questions.

Programme Plan (Do not exceed 5 pages)How do you plan to organize the financial and human resources to complete the research? Outline the schedule for all phases of the proposed project – a Gantt chart can be attached as an Annex.

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AIC ILTC Research Grant Application

Role of Team MembersWhat are the roles and contributions of Co-PI and collaborators? Why are you and your team members particularly qualified to do this? How do the collaborations between the disciplines, institution or with industry add value to the project? Briefly describe the plans for interaction among the team member(s) and with collaborators in achieving the research objectives.

Role of Mentor (Please complete this section only if you are submitting under the New Investigator Grant)Describe how your mentor will help you in completing this research project and achieving the outcomes and indicators set.

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AIC ILTC Research Grant Application

Outcomes & Deliverables /Key Performance IndicatorsPropose 2 or more outcomes and Key Performance Indicators for your project.Indicate how this proposal could generate value for Singapore or the ILTC sector, or provide benefits to Singaporeans.

SECTION 4

Provide an estimated budget and a brief narrative in the “Description” column.

Budget Category

Description Proposed Budget

Expenditure on Manpower(EOM)

What are the types, amounts, and costs of labour required for this program? Link the labour allocations to the proposed technical milestones.

Expenditure on Equipment

What equipment and supplies are required to succeed? Explain why existing infrastructure is unsuitable or unavailable where new purchases are proposed.

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AIC ILTC Research Grant Application

Other Operating Expenses(OOE)

What is the expected unit cost per headcount per year?

TOTAL

Have you obtained other sources of research funding, or are you planning to apply for other sources of research funding for this project? Please indicate the source and quantum obtained or applied for, and the components of the research to be covered by the quantum. Indicate the status of any application.

Please indicate any other in-kind contribution, including manpower, services, consumables or supplies that will be provided for the project. Indicate the source of the contribution.

SECTION 5

Curriculum Vitae of all members in this research study (principal investigators, co-investigators, collaborators and mentors)

Use this format: Name Title Office Mailing Address Email/contact number Current position (to include primary, joint and other academic appointments Academic Qualifications Not more than 5 most important publications in the last 5 years that pertains to

the proposed project Patents filed (related or unrelated to the proposed project) Professional awards Half page summary of the most relevant research outcomes from all previous

grants

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AIC ILTC Research Grant Application

SECTION 6

UNDERTAKING BY PRINCIPAL INVESTIGATOR AND ALL CO-PRINCIPAL INVESTIGATORS

In signing the Grant Application, the Principal Investigator and all Co-PI(s) UNDERTAKE, on any Grant Award, to: Not send similar versions or part(s) of this proposal to other agencies for

funding. Submit supporting documents of ethics approval obtained from the relevant

Institutional Review Board (IRB) for studies involving human subjects. Be actively engaged in the execution of the research and comply with all laws,

rules and regulations pertaining to human ethics, including the Singapore Good Clinical Practice guidelines.

Ensure that AIC’s funding is acknowledged in all publications. Ensure that all publications arising from research wholly or partly funded by

AIC will be forwarded to AIC.

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AIC ILTC Research Grant Application

------------------------------------------------------Name and Signature of Principal InvestigatorDate:

-----------------------------------------------Name and Signature of Co- InvestigatorDate:

-----------------------------------------------Name and Signature of Co- InvestigatorDate:

-----------------------------------------------Name and Signature of CollaboratorDate:

-----------------------------------------------Name and Signature of CollaboratorDate:

-----------------------------------------------Name and Signature of CollaboratorDate:

-----------------------------------------------Name and Signature of CollaboratorDate:

-----------------------------------------------Name and Signature of MentorDate:

-----------------------------------------------Name and Signature of MentorDate:

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AIC ILTC Research Grant Application

SECTION 7

UNDERTAKING BY THE HOST INSTITUTION

In signing the Grant Application, the Host Institution UNDERTAKES, on any Grant Award, to: Provide appropriate support during the grant period. Ensure that the funds provided are used for the appropriate purposes. Ensure that the study complies with all laws, rules and regulations pertaining to

animal and human ethics, including the Singapore Good Clinical Practice guidelines.

Have in place code of practice for research integrity and procedures to deal with unethical research practices.

------------------------------------------------------Name and Signature of Director of Host Institution* Date

* If the Principal Investigator is the Director of the Institution, UNDERTAKING by the Director’s Reporting officer is required.

------------------------------------------------------Name, Designation and Signature Date

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