Application for the financial assistance

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Application for the financial assistance

Particulars of the Principal Investigator:

Name of Principal Investigator

Designation

Address

Telephone/ Mobile No.

E-mail address

Name of Co-PI (if any)

Designation

Address

Telephone/ Mobile No.

E-mail address

Date of birth of PI

Gender of PIMaleFemaleOthers

Academic qualifications of the PI (give details about Medical College/University and the year of passing)

Research experience0 / 180

No of research papers published during last five years

Please give full details of the journal in which the papers have been published0 / 180

Name of the institution/organization in which the study will be carried out (application must be accompanied by a certificate from the head of the institution/organization that all facilities will be made available to the applicant for carrying out the study)

Financial implications of the entire study including duration of study and breakdown of expenditure for every year separately in respect of:

Staff

Equipment

Chemicals, drugs, etc

Contingencies

Existing staff who will be involved in the study

Do you need any additional staff? If so, give details regarding category, qualifications and proposed emoluments for each member of the staff separately

Do you need any additional equipment? If so, give complete details of the equipment. Its estimated cost and country from where it is to be imported if it is not available locally.

Are you getting any assistance for this study from any other source? If so, please give details.

How much assistance you need from the Tuberculosis Association of India. (please give details separately under each item):

Staff

Chemicals

Administration

Miscellaneous, etc

Signature of the Principal Investigator

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Name of the Principal Investigator

Place:

Dated:

Month

Day

Year

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Postal Address

Phone Number

Email Address

Application for the financial assistance

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