National Medial College

Administrative
Financial
Research Proposal
Ethical Considerations

Part I: Administrative Information

1. Research Title

Research Title

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2. Name and Title of Principle investigator

First Name

Middle Name

Last Name

Nationality

Citizenship No.

Passport No. (For Non-Neplease Only)

Address

Phone Number

Mobile Number

Fax Number

Date

Signature

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3. Name of Department associated with principal Investigator

Department Name

Designation

3. Declaration of the Head of the Department

If the proposed research is approved, we will allow him/her to conduct the research in this Department.

First Name

Middle Name

Last Name

Designation

Department

Date

Signature

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5. Name and Title of Co-investigators(if any) responsible for the proposed research. (Use the similar format in a separate document file if more than one)

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First Name

Middle Name

Last Name

Nationality

Citizenship No.

Passport No. (For Non-Neplese only)

Address

Phone Number

Mobile Number

Fax Number

Date

Signature

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6. List the name(s) and institutional affiliation to the researcher(s) (other than co-investigator) to assist your project in Nepal and abroad (if any)

Name

Institution & address

7. Is this research a part of your thesis?

Yes

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NMC-IRC (Proposal Approval Form)

Part I: Administrative Information