Form Section 1a - Face Page
(page limit：1 page)Title of
¨ New ¨ Revision or Amendment
The prior application was submitted in ____ (A. D. year), with the title:
(in English) Budget Requested for Initial Year NT$
Budget Requested for Entire Proposed Project Period NT$
Project involving
Human Subjects ¨ Yes ¨ No Gene Recombination ¨ Yes ¨ No Microbes in Risk Group 2, 3, 4 ¨ Yes ¨ No Vertebrate Animals ¨ Yes ¨ No
Application No.
LEAVE BLANK Serial No.
LEAVE BLANK
Form Section 1b - PI’s History and Statement of Assurance
(page limit：1 page)108CDG (Section 1b) Page No. 1b-1 Projects participated :
Project Period
Project Title
Funding Agency of the Project
Executive Organization
Principal Investigator
Role on Project
Recommenders
1. name / position title / organization / relationship with the applicant
2. name / position title / organization / relationship with the applicant
3. name / position title / organization / relationship with the applicant
Form Section 2a – Key Professional Personnel
108CDG (Section 2a) Page No. 2a-1
Name Position Title/ Highest % Role on
Chinese English Organization Degree Effort Project
Form Section 2a – Key Professional Personnel
(Continuation Page)108CDG (Section 2a) Page No. 2a-2
Name Position Title/ Highest % Role on
Chinese English Organization Degree Effort Project
Form Section 2b – Supporting Staff
108CDG (Section 2b) Page No. 2b-1
Name Position Title/ Highest % Role on
Chinese English Organization Degree Effort Project
Form Section 2b – Supporting Staff
(Continuation Page)108CDG (Section 2b) Page No. 2b-2
Name Position Title/ Highest % Role on
Chinese English Organization Degree Effort Project
Form Section 3a - Abstract in Chinese
108CDG (Section 3a) Page No. 3a-1 Begin with the description of how this proposed application fits in the research fields marked in the FORM SECTION 1-Face Page. This description is very important and will be evaluated during the review process.
page limit：1 page
Form Section 3b - Abstract in English
108CDG (Section 3b) Page No. 3b-1 Begin with the description of how this proposed application fits in the research fields marked in the FORM SECTION 1-Face Page. This description is very important and will be evaluated during the review process.
page limit：1 page
Form Section 4 - Response to Previous Review Comments
108CDG (Section 4) Page No. 4-1 For an amended application, this section is very important. Those who respond to each criticism or suggestion carefully and indicate how and where the application has been improved leave a favorable impression on the review committee. Disregarding the previous review comments by submitting a “New” application may affect the results of the review.
page limit：5 pages
Form Section 4 - Response to Previous Review Comments
(Continuation Page)108CDG (Section 4) Page No. 4-2
Form Section 5a - Research Plan of the Application
108CDG (Section 5a) Page No. 5a-1 Complete this section in the order of all the following components: (A) Specific Aims, (B) Background and Significance, (C) Previous and Current Studies, (D) Research Design and Methods, (E) Anticipated Results, (F) Human Subjects, (G) Gene Recombination, (H) Microbes in Risk Group 2, 3, 4, (I) Animal Investigations, (J) Potential Hazards, and (K) References. Please specify each item in separate paragraphs.
page limit：(A) to (E)－13 pages (B)＋(C)－6 pages (F) to (K)－as needed
Form Section 5a - Research Plan of the Application
(Continuation Page)108CDG (Section 5a) Page No. 5a-2
Form Section 5b - Project Executed by NHRI Researchers
108CDG (Section 5b) Page No. 5b-1 Provide cooperation plan of NHRI researchers in this section including preliminary data, research design and methods, what will be achieved by NHRI researchers in this proposed application, how NHRI researchers will cooperate with the PI, and what will be contributed to NHRI intramural research.
Indicate “N/A” if there is no NHRI participant who will apply for NHRI intramural matching fund.
page limit：10 pages
Apply for NHRI intramural matching fund ❑ Yes ❑ No
※Please be aware of that NHRI researchers are welcome to participate in multiple extramural grants, but each NHRI researcher can apply or conduct only one NHRI intramural matching fund at the same time.
Form Section 6 - Institutional Environment and Resources
108CDG (Section 6) Page No. 6-1 page limit：1 page
Form Section 7a - Initial Year Budget for Personnel
108CDG (Section 7a) Page No. 7a-1 Name Role on Project
Amount Requested (NT$)
Justifications Monthly Annual
Form Section 7a - Initial Year Budget for Personnel
(Continuation Page)108CDG (Section 7a) Page No. 7a-2
Name Role on Project
Amount Requested (NT$)
Justifications Monthly Annual
Form Section 7b - Initial Year Budget for Other Categories (Miscellaneous, Maintenance, Travel, Consumables, Overhead, and Equipment)
108CDG (Section 7b) Page No. 7b-1 Budget Categories and
Items
Amount
(in NT$) Justifications
Form Section 7b - Initial Year Budget for Other Categories (Miscellaneous, Maintenance, Travel, Consumables, Overhead, and Equipment)
(ContinuationPage)
108CDG (Section 7b) Page No. 7b-2
Budget Categories and Items
Amount
(in NT$) Justifications
Form Section 7b - Initial Year Budget for Other Categories (Miscellaneous, Maintenance, Travel, Consumables, Overhead, and Equipment)
(ContinuationPage)
108CDG (Section 7b) Page No. 7b-3
Form Section 8a - Equipment Requested for Entire Proposed Project Period (in NT$)
108CDG (Section 8a) Page No. 8a-1 Year
Equipment Item
(both in English and in Chinese)
Amount
(in NT$) Justifications
Form Section 8a - Equipment Requested for Entire Proposed Project Period (in NT$)
(Continuation Page)108CDG (Section 8a) Page No. 8a-2
Year
Equipment Item
(both in English and in Chinese)
Amount
(in NT$) Justifications
Form 8b - Budget Requested for Entire Proposed Project Period (in NT$)
108CDG (Section 8b) Page No. 8b-1 Budget 1st Additional Years of Support Requested
Categories Year 2nd 3rd 4th
1. Personnel 2. Miscellaneous 3. Maintenance 4. Travel 5. Consumables 6. Overhead*
7. Equipment Total
* Overhead (6.) ≦10% of (1.~5.)
Total for Entire Proposed Project Period: NT$
Justifications
Identify and justify any significant increase or decrease over the initial project period for the extramural grant.
Form 8b - Budget Requested for Entire Proposed Project Period (in NT$)
(Continuation Page)
108CDG (Section 8b) Page No. 8b-2
Form 8b - Budget Requested for Entire Proposed Project Period (in NT$)
Budget Categories
1st Year
Additional Years of Support Requested
2nd 3rd 4th 5th
Extra Intra Extra Intra Extra Intra Extra Intra Extra Intra
1.Personnel 2.Miscellaneous 3.Maintenance 4.Travel 5.Consumables 6.Overhead*
7.Equipment Total
* Overhead (6) ≦ 10% of (1.~5)
Total Extramural Grant Budget for Entire Proposed Project Period: NT$
Total Intramural Matching Fund for Entire Proposed Project Period: NT$
Total Extramural and Intramural Budget for Entire Proposed Project Period: NT$
Justifications
Identify and justify any significant increase or decrease over the initial project period for the extramural grant and intramural matching fund.
108CDG (Section 8b) Page No. 8b-1
If applying for NHRI matching fund
Form 8b - Budget Requested for Entire Proposed Project Period (in NT$) (Continuation Page)
108CDG (Section 8b) Page No. 8b-2
If applying for NHRI matching fund
Form Section 9 - Other Support
Name / Roleon Project Source of Support Title of Support Funding (in NT$) Duration of Support
Funded / Pending
Overlap with this Application Current Year Total
108CDG (Section 9) Page No.9-1_
Form Section 9 - Other Support
(Continuation Page) Name / Roleon Project Source of Support Title of Support Funding (in NT$) Duration of Support
Funded / Pending
Overlap with this Application Current Year Total
108CDG (Section 9) Page No.9-2
Form Section 10 - Biographical Sketch
(page limit：4 pages for each person)108CDG (Section 10) Page No. 10-1
姓 名 ID No.(身份証或護照字號)
Name(in Print) Date of Birth (mm/dd/yyyy)
Gender ¨Male ¨Female
Education:
Institution and Location Degree Year Field of Study
Complete this section in the order of the following components:
（1） Statement of Qualifications for Career Development Grant (For PI only)
（2） Research and Professional Positions Held in Chronological Sequence
（3） Record of Serving as Principal Investigator
（4） Publications (Patents, invention reports, technology transfer or licensing can also be included.)
Form Section 10 - Biographical Sketch
(Continuation Page)108CDG (Section 10) Page No. 10-2
Form Section 11 – Certificate of Agreement for the Application
Project Period From January 1, 2019 To December 31, 2022 Endorsement for the Principal Investigator (PI) :
I hereby promise that if this CDG application is awarded, the PI will have the facility support (including space) described in the application and independent research position to effectively execute this grant. Also non-academic activities of the PI will be reduced. I am aware that any falsification or misrepresentation of this application may seriously damage the credibility of the sponsoring organization.
Signature of the Head of Sponsoring Department / Institution : ___________________________________
Name :(print) Title :(print) Date :
Signature of the Head of Applicant Organization: ________________________________________
Name : (print) Title :(print) Date : Principal Investigator’s Statement of Assurance:
I hereby assure that I meet the qualifications required to apply for this CDG grant and that the proposed research to be conducted in this study has not been submitted to, nor has it received any financial support from, any other funding agency. I am also aware that any falsification, misrepresentation or withholding of any information in this application may result in administrative actions such as the dismissal of my application, termination of the award and/or possible punitive actions.
Signature of Principal Investigator : ______________________________________________
Name :(print) Date : ___________________
(Use continuation pages if necessary) Signature of Key Professional Personnel
I hereby agree to participate in this CDG application; and have provided full and accurate information including biographical sketch and all governmental supports that were funded in the past 3 years and all current pending applications. I am aware that any falsification, misrepresentation or withholding may result in disqualification of the application.
Role on Project Name
(in English) Organization/Department Signature/Date
Form Section 12 – Checklist
108CDG (Section 12) Page No. 12-1
CHECKLIST
(CDG)Before submitting the proposal to the NHRI, please check the following items carefully. Make certain that the application meets the administrative criteria; any shortage or flaw may affect the review result or even the application may be returned directly without review.
❑ read the Guidelines very carefully, each investigator can conduct CDG project only once
❑ use the NHRI application form to apply
❑ conform the qualifications for Principal Investigator, Co-Principal Investigators, Investigators, and Applicant Organization to the rules of application
❑ use English only (except for Chinese title of application, Chinese abstract, Chinese name of biographical sketches and those items requested in Chinese)
❑ Be aware of that this application fits in the research fields listed in the Chinese manual on page I-2~I-4and have description of how this proposed application fits in the research fields in FORM SECTIONS 3a and 3b
❑ Do not exceed 100 typewriter spaces (including the spaces between words and punctuation) for the application title
❑ keep the page limit for each section
❑ number pages consecutively at the right bottom for each section respectively
❑ have signatures of Principal Investigator, the Head of Applicant Organization, the Head of Sponsoring Department/Institution, and key professional personnel in Form Section 11
❑ 3 letters of recommendation must be supplied
❑ the entire proposed project period should be 4 years
❑ budget requested for entire proposed project period must not exceed NT$8,000,000 (and annual NHRI intramural matching fund do not exceed NT$1,000,000, if any.)
❑ the amount of each budget category is correct
❑ send five copies of the color photographs to NHRI if necessary
❑ have responses to previous review comments and upload these original comments as appendixes for revised application
❑ include certifications of all IRB and application contents (including Data and Safety Monitoring Plan) if any human subjects involved
❑ include certifications of all IACUC along with description of animal ethics 3Rs if any vertebrate animals involved
❑ include certification of relevant biosafety committee if any gene recombination or microbes in risk group 2, 3, 4 involved
❑ upload all the abstracts of funded grants in the past three years and all current pending applications, not limited to the ones supported by NHRI
❑ provide the collaborative agreement or supporting letters if there is any sponsor, consultant or cooperation laboratory listed in this application
❑ besides turning in the official notification in hard copy, please send electronic files of the proposal and appendix through the online system (http://erad.nhri.org.tw) which is the only way for submission (including fill-in forms and upload files)
Typing instructions:
❑ single space
❑ within the margins of limitation
❑ standard font size (density is 12 points) and no more than 6 lines per vertical inch
❑ black type
❑ photos or other illustrative materials must be presented in the body of the application and should be readable
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