Samih Darwazeh Innovation Grant Application Form

1. ASRF PROPOSAL APPLICATION FORM
Innovation Grant Scheme
Revision 6.2,
Jan. 2012

2. TABLE OF CONTENTS
1. Introduction and Funding Conditions........................................................................................................3
2. Cover page..................................................................................................................................................4
Title of the research proposal.......................................................................................................4
Project Acronym............................................................................................................................4
Project summary...........................................................................................................................4
Organization that administers the research grant details..............................................................4
Research team .............................................................................................................................5
Classification of grant proposal / research field............................................................................5
Proposal keywords........................................................................................................................5
Fund and duration summary.........................................................................................................6
Co-funding/ other funding resources.............................................................................................6
3. Concept and objective................................................................................................................................7
Introduction...................................................................................................................................7
Concept / statement of the problem .............................................................................................7
Objectives.....................................................................................................................................7
Expected outcomes......................................................................................................................8
4. State-of-the-art...........................................................................................................................................9
Literature research........................................................................................................................9
Patents research ..........................................................................................................................9
5. Implementation and Methodology...........................................................................................................10
Scientific methodology and experiments.....................................................................................10
Project plan.................................................................................................................................10
Project work packages ...............................................................................................................10
Project milestones.......................................................................................................................11
Project schedule.........................................................................................................................12
Research team............................................................................................................................12
Research team capability statement...........................................................................................13
Facilities, equipment & other resources......................................................................................14
6. Financial requirements and justification..................................................................................................15
Budget 15
Other major financial resources..................................................................................................17
7. Impact and dissemination ........................................................................................................................18
Results dissemination plan.........................................................................................................18
Management of intellectual property...........................................................................................18
Industrial involvement and exploitation of the results..................................................................18
Contribution to community and societal objectives.....................................................................18
8. Ethical issues ...........................................................................................................................................19
9. Certification..............................................................................................................................................20
10. Checklist for submitting the research proposal......................................................................................21
11. Reviewers suggestion.............................................................................................................................22
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3. 1. Introduction and Funding Conditions
Applied Scientific Research Fund (ASRF) is an Arabic non-government, non-profit organization,
created by Samih Darwazah, founder of Hikma Pharmaceuticals, to foster and enable innovation
through various funding schemes for applied researches and commercialization activities as well as to
create the culture of research and innovation in the Arab region.
 Funding scheme objectives:
◦ Support innovative ideas by starting from R&D and focusing on the value of the impact of
the results and finally commercialization
◦ Accelerate the commercialization process by moving from the research idea to prototype
 Eligibility:
◦ Researchers and inventors
◦ Research centers and universities
 Conditions to be a candidate project:
◦ Quality of scientific proposals and contribution to science
◦ Technical feasibility of the project
◦ Market potential and feasibility
◦ Clear, tangible and measurable outcomes
◦ Impact and quality of the prospected results
 ASRF’ Support (up to 100,000 JD over 2 years) that can include::
◦ Material and equipment
◦ Research and implementation cost
◦ Prototype design and development
◦ Full lab-scale demonstration and technical testing
◦ Material and implementation costs
◦ Technical and prototype testing
◦ Conducting field studies
 Intellectual Property ownership:
◦ ASRF owns the resulting IP
◦ ASRF and the inventor share royalty from sales/commercialization according the
agreement signed between the two parties
 Contribution to ASRF and /or the community:
◦ The team agrees to provide technical reports and progress on their project at regular
predefined intervals (quarterly every 3-6 months) based on the support/funding agreement.
◦ The team agree to deliver public training/workshops on their technical field of expertise as
it relates to the research that is equivalent to 1 day public workshop/training
◦ Agreeing to press and promotion as part of the ASRF marketing and communication
campaign, with teams prior approval of content.
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4. 2. Cover page
Title of the research proposal
Concise & descriptive title (No more than 20-25 words)
Project Acronym
Project summary
(1 page max)
• Include a self-contained description of the activity that would result if the proposal is funded.
Include a statement of objectives and methods to be employed.
• Summarize project goals and expected outcomes, including how they pertain to broader impacts.
• Describe specific goals, methodology, long-term objectives, expected results
Organization that administers the research grant details
Organization’s Name
Division or Department
Title & Name of
Head/Chairman
(Authorized representative
of the organization)
City
Country
Address
Phone
Fax
Email of the contact
person
Website
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5. Research team
Investigator/researcher1
Name Title/Position Institute3
PI (Principle Investigator)
Co-I 1 (Co-Investigator)
Co-I 2 (Co-Investigator)
Co-w1 (Co-worker)2
Co-w2 (Co-worker)
Note1: Only PI & Co-I are considered to the IP (Intellectual Property) rights
Note2: Co-workers (employees or contractors) may be determined later after the grant/fund is approved. Co-workers are not considered to
the IP (Intellectual Property) ownership rights
Note3: The PI (Principle Investigator) must be affiliated with the organization that will administer the grant
Classification of grant proposal / research field
Classify your proposal under each of the following areas. (Multiple fields can be selected but indicate the
main field with “M”)
Acronym Scientific Area Field Selection
AF Agriculture, Food and Fisheries Sciences
BT Biotechnology
CI Chemical Industries
DM Drugs & Medicines
EE Electrical & Electronics Technologies
EG Energy (including renewable energies)
EN Environment, (including Climate Change)
HE Healthcare
IT Information and Communication Technologies
MC Mechanics & Construction
NN Nanosciences, nanotechnologies, materials & new
production technologies
NS Natural / Pure science
SE Security and Safety
SH Socio-economic Sciences and the Humanities
TT Transport & logistics
WA Water, Waste & Utilities
OT Other: Please specify
Indicate research subfields
Proposal keywords
To facilitate selection of evaluators / indexing / promotion/ etc
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6. Fund and duration summary
Requested Fund amount (in JOD)
(10 to up to 100K)1
Project Duration (in Months)
(6 to 24 Months)1
Note1: Justification must be provided for requested funds more than 100K JOD or more than 24 Months and will be subject
for approval by the fund management and the evaluation committee
Co-funding/ other funding resources
Is this research proposal co-funded by other agency? If yes please attach the funding agreement and the
proposal (will be considered in the evaluation)
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7. 3. Concept and objective
Introduction
Provide a basic but thorough introduction to your subject. Don’t expect reviewers to be familiar with
your field so you should include clarifying information for your project. Reviewers are an intelligent, yet
diverse audience. State your overall vision and motivating rationale. What is lacking? Provide
background and need/significance. Do you have preliminary results?
(one page max)
Concept / statement of the problem
• State the problem that you are trying to solve
• State limitations of existing/current solutions and how such problems are solved or worked
around with existing technologies
* Be sure to cite any references mentioned in the Project Description.
(Two pages max)
Objectives
State main objective of the proposed research and its significance
(One page max)
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8. Expected outcomes
(DISCUSS ALL FOLLOWING 5 POINTS)
• Research project outcome
(Provide specific, measurable outcomes)
• Novelty and innovation
(Explain any new features or approaches in your research work)
• Beneficiaries of the results and how they might utilize the results.
(Avoid the obvious general benefits and focus on specific, measurable benefits)
• Prospects for a commercial potential.
(New applied ideas, new technologies, new applications, prototypes, startups, etc.)
• Patents and papers
(Four pages max)
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9. 4. State-of-the-art
Literature research
• State cites references related to this project
• Critically analyze relevant and recent literature with a point of view of defining what has been
done and what is needed
(two pages max)
Patents research
State published patents related to this project
(You can use the following links for patents search)
• http://www.google.com/patents
• http://www.wipo.int/pctdb/en/
• http://www.epo.org/searching.html
• http://ipco-jo.org
(one page max)
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10. 5. Implementation and Methodology
Scientific methodology and experiments
Explain the scientific methodology and suggested experiments and procedure
(two pages max)
Project plan
• Describe on a high level the followings: (more details in next section)
• Describe the project Activities and its relation and effectiveness in achieving the project goals.
• Describe the time plan
• What facilities and resources are available and how they are going to be used?
• Include for each Objective of the project: (1) Methods/Activities (2) Expected
Results/Deliverables (3) Limitations & alternatives & (4) Timeline/Resources if needed
Project work packages
Organize the activities to achieve the project in work packages with clear description, actions, durations
and expected deliverables. Link the work packages to project objectives
(THIS SECTION WILL BE UPDATED, CONSIDERED AND ATTACHED TO THE FUNDING
AGREEMENT)
Work Package Title Duration (months) Expected End Date
WP1
WP2
WP3
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11. Work Packages Description1
Work package no.
Work package title
Expected Starting date WP Duration
Researcher No. PI Co-
I1
Co-
I2
Co-
I3
Co-
w1
Co-
w2
Co-
w3
Person-months per researcher2
Objectives
Description of activities (possibly broken down into tasks) and role of partners
Deliverables and expected outcomes
Note1: Include separate table for each work package
Note2: If a researcher is not participating in this work package add 0 under his/her number
Project milestones
(THIS SECTION WILL BE UPDATED, CONSIDERED AND ATTACHED TO THE FUNDING
AGREEMENT)
Milestone no. Milestone name WPs involved Expected date1
M1
M2
Note1: Researchers will be compensated upon completion of each milestone
Milestone
no.
Means of verification1
M1
M2
Note1: Describe how the milestone achievement will be measured or verified (for example, achieved certain tests, delivery of
prototype, buying equipment, etc.). Should be measurable to be included in the grant contract
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12. Project schedule
Start date and duration
Proposed start date
Duration of the project in
months
Timeline
Work
Package
Months
2 4 6 8 10 12 14 16 18 20 22 24
WP1
WP2
WP3
Research team
(THIS SECTION WILL BE ATTACHED TO THE FUNDING AGREEMENT)
Principal & co-investigators summary
Principal Investigator (PI) Details
Title and Position
First Name
Last Name
Organization
Division or Department
Address
Mobile Phone
Fax
Email
Web
Co- Investigator 1
Details1
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13. Title and Position
First Name
Last Name
Organization
Division or
Department
Address
Mobile Phone
Fax
Email
Web
Note1: Include table for each Co-Investigator and co-worker if known
Note2: Co-workers are employees/contractors and do not share the IP ownership
Research team capability statement
• Describe the competencies and skills of the research team why they are suitable for the project
and can achieve it.
• What are Previous researches conducted by the investigator(s) in the project proposal field
• What are their publications and patents in this field, Provide most significant and recent
publications, fellowships/contracts awarded, papers presented
• What other/previous research projects the team members have managed
• Please attach the CVs of the research team
(4 pages max for the whole team)
PI:
Co-I1:
Co-I2:
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14. Facilities, equipment & other resources
Describe the facilities, labs, tools and equipment to be used in the project
Equipment
Code
Equipment Name Location1,3,4
Accessibility2,3
Cost of use
Eq1
Eq2
Note1: Where is this equipment physically located in the country of research (which institute, department, etc.).
Note2: Are there any specific accessibility conditions or requirements
Note3: If the equipment is not available in the country of research indicate that
Note4: If the equipment is located in the institute that administers the grant will be part of the institute participation in the
project
Equipment Code Time of use1
Justification of use2
Note1: For how long this equipment will be used
Note2: Why this equipment is needed for the project
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15. 6. Financial requirements and justification
Budget
Provide detailed budget for first 12 months and estimates for all following years (submit detailed budget
each year)
Budget summary
Item Amount
Year 1
Amount
Year 2
Note
Equipment
Human Resources
(manpower)
Travel * only to access
equipment, facilities or do
some tests outside the
research location
Dissemination (Patents,
etc.) * papers/conferences
are not covered
Material / Consumables
Services
Manpower expenses
(SUBJECT TO APPROVAL AND SPECIAL CONDITIONS MIGHT APPLY IN THE GRANT
AGREEMENT)
Position No. Monthly
Rate (MR)
Duration of
Involvement in
months (DOI)
% of Full Time subtotal Cost JOD
(No x MR x DOI x %)
Research
assistant
Total
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16. Travel expenses
(EACH TRIP MUST BE DIRECTLY APPROVED BY THE FUND MANAGEMENT 90 DAYS BEFORE
THE TRAVEL)
To From Purpose of travel days Ticket Daily
Lodging
Subtotal
Total Travel Expenses
Consumables expenses
Description Qty. Unit
(kg. m, pack,
…)
Unit
Price
Subtotal
Total
Equipment cost
(SPECIAL CONDITIONS IN THE GRANT AGREEMENT MIGHT APPLY FOR PURCHASING THE
EQUIPMENT)
Equipment
code
Country of
Origin
Delivery
Time
Qty. Unit Price Import duty Tax Subtotal
Eq.1
Total
Services/facilities give details of needed facilities
Description Proposed Usage Cost
Total
Other items (e.g. dissemination)
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17. Description and Justification Cost
Total
Other major financial resources
Support for this Projects from other sources
Funding
Agency
Amount in
cash
Amount in
kind
Funded activities
Please provide the followings: (COPIES OF ALL DOCUMENTS MUST BE ATTACHED)
• Funding agreement(s) and proposal(s)
• IP ownership of the results
• Stage of development / progress
• Research results reports
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18. 7. Impact and dissemination
Results dissemination plan
How will results be broadly conveyed? Patents, spin-off companies, papers, special seminars, etc.
(two pages max)
Management of intellectual property
How the results will be protected, managed and shared among team, institutes and funders
(one page max)
Industrial involvement and exploitation of the results
How will you exploit the results, who might be interested (industry, companies, institutes, etc.) in the
results and do you have clear plan how to involve the industry
(one page max)
Contribution to community and societal objectives
Describe how the results of the project will have impact on some or all of the followings
• Quality of life
• Health and safety
• Employment
• Environment
(two pages max)
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19. 8. Ethical issues
Please complete the form “04 Ethics Checklist.docx”
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20. 9. Certification
In submitting this research proposal, we confirm on behalf of the Administrative Authority of the
submitting organization(s) and partner organizations that:
• The information in the proposal submitted is true and complete.
• The proposal idea is original and the result of intellectual activities of the PI and Co-Is
• The research is scientifically applicable and has potential for industrial application
• The Team (PI & Co-Is) are responsible for the delivery of the stated work packages, milestones
and the expected results
• The team is responsible to report the achievements and resulted IPs to the granting institute
Name Signature Date
Principal Investigator
Person in Charge of
Authorizing
Organization as Host for
Project
Co-Investigator 1
Co-Investigator 2
Co-Investigator 3
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21. 10. Checklist for submitting the research proposal
Item Yes No
Cover Page
Concept and objective
State-of-the art
Implementation and methodology
Financial requirements and justification
Impact and Dissemination
Ethical Issues
Certification
Not exceeded the page limitation
Co-funding documents attached
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22. 11. Reviewers suggestion
Could you please suggest 3 referees, reviewers or experts in the field of your research to consult for the
assessment?
Name
Organization’s Name
Division or Department
City
Country
Address
Mobile Phone
Fax
Email
Website
Name
Organization’s Name
Division or Department
City
Country
Address
Mobile Phone
Fax
Email
Website
Name
Organization’s Name
Division or Department
City
Country
Address
Mobile Phone
Fax
Email
Website
Applied Scientific Research Fund (ASRF)
 Email: info@asrf.jo
 Tel: +962-6-515-5095
 Fax: +962-6-516-1399
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