Three (3) copies of this form must be submitted to the Malaysian Thoracic Society, Suite 2-3, Medical Academies of Malaysia, 210 Jalan Tun Razak 50400 Kuala Lumpur Malaysia
(Incomplete form will be rejected)
A / TITLE OF PROPOSED RESEARCH
B / DETAILS OF PRINCIPAL RESEARCHER
B(i) / Name of Principal Researcher:
Identity Card or Passport No.:
B(ii) / Position/Designation:
B(iii) / Institution/Organisation:
Department/Unit:
Address:
B(iv) / E-mail Address:
Office and Mobile Phone No: / Office:
Mobile:
Fax No (if any):
C / RESEARCH CLUSTER/GROUP
C(i) / Are you a member of any research collaborative group/cluster? If any, please state:
C(ii) / Name of Research Institute/Centre/Laboratory/Group:
C(iv) / Duration of proposed research (maximum 24 months):
months
From: (month/year) to (month/year)
C(v) / Co-researchers:
No / Full Name / IC or passport No. / Academy/Faculty/
Centre/Unit
1
2
3
4
5
D / RESEARCH PROPOSAL
Summary of Research Proposal (maximum 300 words)
(Please include background of research, literature review, objectives, research methodology, Gantt Chart/Flow Chart of research and references)
Research Background (including hypothesis/research questions and literature review)
Research Objective(s)
Research Methodology
Please provide:
1.  Description of Methodology
2.  Gantt Chart of Research Activities (enclose appendix)
3.  Milestones and dates (enclose appendix)
Expected Research Outputs
E / BUDGET
Please provide the estimated budget for the proposed research as well as the details of expenditure according to the guidelines attached. Researchers can apply for funding up to a maximum of RM 50,000 per year for a period of not more than 2 years.
Budget Details / Amount Requested (RM)
Year 1 / Year 2
Salary and Wages
Overtime
Travelling Expenses and Subsistence
Please provide details for all items with the amount requested
Communication and Utilities
Rental
Equipment
Research Materials and Consumables (including animals, plants and seeds for research)
Maintenance and Minor Repair and Services
Professional Services and Other Services (including journal page charge for publication and hospitality for consultants/advisors)
Others
TOTAL AMOUNT (RM)
Signature of Principal Researcher: ………………………………………………
Date:

Nota: All applications submitted will be treated in full confidence and the decision of the vetting committee is final.

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24 Nov 2014