Section A (Where applicable, Part I or Part II should be completed by the Principal Investigator/Proposer)

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1 Form RC/3 (Revised in Sep 2017) Application for Departmental General Research Funds Notes: 1. Please fill in Section A and pass it to the Departmental/School Research Committee (D/SRC) for completion of Section B, and then send a copy to the Research Office (RO) for action/record. 2. Full-time academic staff in PolyU substantive staff grades mapped to grades A-I as defined by the UGC (except visiting or temporary academic staff) and those senior executives who are appointed to a non-academic position and are offered a concurrent appointment as academic staff members by the University will be eligible to act as Principal Investigators (Pls) for internal funding schemes. 3. Please note that all the information and personal data you have submitted in connection with this grant application, together with the subsequent assessment information, may be made available to various parties concerned for the purposes of grant application, research project monitoring and administration, and for other related purposes. Section A (Where applicable, Part I or Part II should be completed by the Principal Investigator/Proposer) (I) APPLICATION FOR GRANT TO SUPPORT RESEARCH PROJECT: Project Title Performance Pledge: The RO will set up a project account within 14 working days (on receipt of a full and complete application, and appropriate approval) Account No. (for grant extension)# # An account cannot be re-activated if it has already been closed before the current financial year (i.e., 1 July of the year 30 June of the following year). Researchers PolyU Staff No. Title (Prof., Dr, Mr, Ms) Surname Other Names Dept. and Cost Centre Post Ext. Principal Investigator (PI) Co-Investigator 1 Co-Investigator 2 Co-Investigator 3 Project Type (Please tick the appropriate box below) New research project (Please attach the proposal and complete 1-8, where applicable.) I would like to carry out the research because (please tick only one of the following justifications): (a) The research is in line with the core research strength and development of the University. (b) It is a new area of research development which is worth exploring. (c) It is contributory to accomplishing the societal mission of the University. If you want to provide more details of the reason to conduct the research, please do so in the following box: 1

2 Grant extension to an ongoing project for Salary/ MPF/ Equipment/ General Expenses/ Conference Attendance* (* Please delete as appropriate and complete 1, 2 and 7, where applicable. Please also attach a revised proposal or explain why grant extension is needed [what to achieve by the additional grant] in the space provided below [if there is not enough space to list your justifications, please attach additional pages].) Total Funding Requested for this Application: $ 1. Cost breakdown and list of items of expenditure: Salary/ $ for ($ x months) Stipends* (position) (no.) Employer s MPF contributions (5% of the employee s monthly income or $1,500, whichever is less) $ General Expenses $ Please itemise ($) Please itemise ($) Conference Attendance $ 2. Details of other funds, if already secured: $ from (e.g., Departmental Earnings Account, external funding bodies) 3. Duration of Project months Start Expected Completion (The Start of your project must be within nine months of the Grant Allocation which is the date when the account is set up by the RO. Please be prepared to apply for an extension of the project if you encounter a legitimate delay in executing the project after its start date.) 4. Please provide up to 4 key words for your project: First Third Second Fourth 5. Research Ethics/Safety Approval (Please read the policy and procedures for safety approval available at the Health, Safety & Environment Office website. For projects involving human subjects, ethical approval must be obtained. Please refer to the Guidelines for Ethics Review for Research/Teaching Projects Involving Human Subjects in Appendix 6(g) of Research Handbook for details.) I/We confirm that approval (* Please tick as appropriate): * has been * is not *will be obtained obtained required before the start of the project Human Research Ethics 2

3 Animal Research Ethics Biological Safety Ionizing Radiation Safety Non-ionizing Radiation Safety Chemical Safety 6. Declaration (To be completed by the Principal Investigator who does not have a doctoral degree) Please tick only one of the following: (i) (ii) (iii) I am registered for a higher degree. I declare that this project does not overlap with my higher degree studies. If I later register for a higher degree/ an additional higher degree, I will report this to the RC and I understand that the grant may be withdrawn if it is considered that a potential overlap exists. I will not register for a higher degree in the future. 7. I have read the Information for Principal Investigators on the Award of University Research Grants in Appendix 4(a) of Research Handbook. I agree to comply with the rules, regulations and conditions, if I am subsequently awarded a research grant for this project. I also declare that the Co-Investigator(s), if any, listed on page 1 of this form and in the attached proposal has/have agreed to participate in this project as planned if this proposal is subsequently supported. Principal Investigator 8. Declaration [To be completed by internal Co-Investigators (Co-Is) who do not have a doctoral degree] Please tick only one of the following: Co-I 1 Co-I 2 Co-I 3 (i) I am registered for a higher degree. I declare that this project does not overlap with my higher degree studies. (ii) If I later register for a higher degree/ an additional higher degree, I will report this to the RC and I understand that the grant may be withdrawn if it is considered that a potential overlap exists. (iii) I will not register for a higher degree in the future. (Co-I 1) (Co-I 2) (Co-I 3) 3

4 (II) APPLICATION FOR RESEARCH ACTIVITIES: Note to Proposer: The funds can also be used for non-project-based research activities, such as to acquire research facilities including equipment, software and hardware, and fund justifiable activities to promote, develop, encourage and enhance research in general (except for the purpose of recruiting research personnel). Note to D/SRC Chair: Please inform the Proposer of your decision and send a copy to the RO for record. If you are the Proposer, please seek your FRC/Dean of School s approval accordingly. 1. Details of the proposed item/activity to be supported by the Departmental General Research Funds: 2. Funding request: $ (Breakdown) Name Proposer Section B1: (To be completed by the Departmental/School Research Committee) Decisions of Departmental/School Research Committee: Name Chair, Departmental/School Research Committee 4

5 Section B2: [To be completed by the Faculty Research Committee/Dean of School if the D/SRC Chair is a member of the research team or the Proposer (see Section II)] Decisions of Faculty Research Committee/Dean of School: Name Chair, Faculty Research Committee/Dean of School Section B3: (To be completed by the Chair of the Research Committee if both the D/SRC and FRC Chair/Dean of School are members of the research team) Decision of the Research Committee: Chair, Research Committee 5