AMERICAN UNIVERSITY OF BEIRUT

FACULTY OF MEDICINE

RESEARCH PROPOSAL FORM

Submit this form if:

1. You are submitting this proposal for intramural funding, or
2. You are submitting this proposal for review by the IRB and not requesting funding.

For proposals seeking extramural funding, please fill the coversheet provided by the Grants and Contracts Office.

TITLE OF PROPOSAL:                                                                                                      

                                                                        Name                                      Signature

PRINCIPAL INVESTIGATOR:                                                                                           

FACULTY:                                                                                                                            

DEPARTMENT:                                                                                                                    

DATE OF SUBMISSION:                                                   

[      ]  New Proposal                                       [    ] Renewal

SUBMITTED TO:

[   ]   UNIVERSITY RESEARCH BOARD RESEARCH FUND*

[   ]   MEDICAL PRACTICE PLAN RESEARCH FUND

            [   ]   DIANA TAMARI SABBAGH RESEARCH FUND

[   ]   INSTITUTIONAL REVIEW BOARD APPROVAL ONLY

PROPOSED ANNUAL BUDGET:                                                                         

STARTING DATE OF STUDY:                                                                 

DATE OF STUDY COMPLETION:                                                           

COLLABORATORS:

NAME                                     SIGNATURE                          AFFILIATION

APPROVALS:                                               Signature                                Date

DEPARTMENT CHAIRPERSON:                                                                                    

* Please fill the cover sheet requested for URB submissions.

Please attach updated CV, signed and dated, to each copy of the proposal.