SAMRC-FORTE
Collaborative Research Programme
SAMRC/FORTE-RFA-01-2016
APPLICATION FORM
Instructions
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Applicants for Category 1 and 2 funding must complete sections 1, 2 and 4 of this form.
Applicants for Category 3 funding must complete sections 1, 3, and 4 of this form.
Use Arial font size 10, single spacing to complete the application form.
The proposal may not exceed 20 pages, excluding the annexures.
Applications submitted should contain the signatures of the submitting Principal Investigators of both
South Africa and Sweden as well as the Research Authorising Officer for the South African Institution and
the authorised representative at the Swedish Administrative organisation.
Completed applications must be sent to Ms Arlene Smith, Project Administration: Strategic Research
Initiatives, SAMRC ([email protected]).The closing date for applications is 29 February 2016. Late
applications will not be accepted. (Internal closing date at Stellenbosch University: 24 February 2016)
1. PRINCIPAL INVESTIGATORS (PIs) DETAILS
South Africa
Sweden
Title
Name & Surname
Citizenship &
ID/Passport
number
University /
Institution
Position
Department /
Faculty
Postal & Physical
Address
Contact No.
Office:
Cell:
Office:
Cell:
Email
Gender
Population group
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(not applicable)
2. PROJECT PROPOSAL (Category 1 & 2 funding only)
Project title
Project acronym (optional)(Max 10
letters)
Project abstract (max 1 page)
 Provide a brief synopsis of the background, aims, methods and anticipated outcomes of the proposal.
i.
Problem identification (max 3 pages)
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Give a brief description of the health or scientific research problem that will be addressed by the proposed project, and
Outline the nature, source, extent and impact of the problem to be addressed, giving particular attention to the extent of the problem
in South Africa and Sweden.
ii. Rationale and motivation (max 3 pages)
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Provide a background and scientific rationale for the proposed research, outlining, where appropriate, the theoretical framework that
forms the basis of the research, and discussing how the proposed research will address the problem identified above, and
Indicate how the proposed research is expected to contribute to an integrated, cross disciplinary research programme advancing
health-relevant knowledge and/or contribute to improvements in health outcomes.
iii. Research aims and objectives (max 2 page)
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Outline the main aim(s) of the proposed research and specify the research objectives that are to be achieved.
iv. Research design and methods (max 6 pages)
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Noting that the overarching goal of the programme is to support innovative, inter-disciplinary, collaborative research projects that
address both South African and Swedish health problems, give an account of the overall research approach and the following:
specifics of the research design, including any multi-disciplinary aspects and/or stakeholder interactions;
the research methods and/or experimental techniques to be employed including human subjects protection plan for clinical
studies;
the data collection and analysis strategies / approaches to be adopted;
the statistical treatment and analysis of data, and
responsibilities and timelines in doing the work, including communication and collaboration activities (who will do what when?)
Applicants should give a detailed account, as required above, of the targeted outcomes in each of the three years (max) of their
proposed research. The research design and methods should be well aligned with the stated research aims and objectives.
v. Expected outputs / outcomes / impact (max 4 pages)
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Outline the expected direct and/or indirect outputs/outcomes/impact of the research in terms of the collaborative research
programme goals outlined in section 4 of the RFA. It includes:
the advancement of scientific/health knowledge;
human capacity development (number of post graduates trained and post-docs mentored);
specific research outputs (e.g. publications in high impact journals), and
contributions the research is envisaged to make to improvements in health outcomes.
Names and affiliations of other researchers/students participating in the project in South Africa and
Sweden as appropriate
Full name and nationality
Degree
Institution/s
SA or
Student or
Population
Sweden researcher
group (SA only)
/ Gender
vi.
vii.Budget (Attach as Annexure to the application)
Provide a detailed budget with justification for all three years of the project on a Microsoft Excel spreadsheet. Please note the allowable
and non-allowable costs listed in the RFA.
Overall Budget
Distribution
Applied for at
SAMRC (ZAR)
Applied for at Forte
(SEK)
2016
2017
2018
Total
3. PROPOSAL (Category 3 funding only)
Proposed research focus area
i.
Problem identification (max 2 pages)
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
Give a brief description of the health or scientific research problem that you wish to address, and
Outline the nature, source, extent and impact of the problem to be addressed, giving particular attention to the extent of the problem
in South Africa and Sweden.
ii. Rationale and motivation (max 3 pages)


Provide a background and scientific rationale for the proposed research, outlining, where appropriate, the theoretical framework that
will form the basis of the research, and discussing how the proposed research will address the problem identified above, and
Indicate how the proposed research is expected to contribute to an integrated, cross disciplinary research programme advancing
health-relevant knowledge and/or contribute to improvements in health outcomes.
iii. Proposed research aims and objectives (max 2 page)

Outline the main aim(s) of the proposed research and specify the research objectives that are to be achieved.
iv. Proposed activities in year 1 (max 2 pages)
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Noting that the overarching goal of the programme is to support innovative, inter-disciplinary, collaborative research projects that
address both South African and Swedish health problems, give an account of your overall approach to identifying/collaborating with
researchers in the partner country. These may include:
travel to partner institutions
staff exchange
workshops
study tours
v. Expected outputs / outcomes / impact (max 2 pages)

Outline the expected direct and/or indirect outputs/outcomes/impact of the proposed research in terms of the collaborative research
programme goals outlined in section 4 of the RFA. It includes:
the advancement of scientific/health knowledge;
human capacity development (number of post graduates to be trained and post-docs mentored);
specific research outputs (e.g. publications in high impact journals), and contributions the research is envisaged to make to
improvements in health outcomes.
vi. Budget (Attach as Annexure to the application)

Provide a detailed budget with justification for year 1 activities on a Microsoft Excel spreadsheet. Please note the allowable and
non-allowable costs listed in the RFA.
Overall Budget
Distribution
Applied for at
SAMRC (ZAR)
Applied for at Forte
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2016
(SEK)
4. SIGNATURES
SWEDISH PI
Name (please print)
Position:
Signature
Date
SOUTH AFRICAN PI
Name (please print)
Position:
Signature
Date
DECLARATION BY THE RESEARCH AUTHORISING OFFICER (SOUTH AFRICAN INSTITUTION)
I declare that the (Name of Institution) ………………………………………………………………………. approve of
and authorise this application to the SAMRC.
Name
Position:
Signature
Date
DECLARATION BY THE AUTHORISED REPRESENTATIVE OF THE ADMINISTRATIVE ORGANISATION
(SWEDISH INSTITUTION)
I declare that the (Name of Institution) ………………………………………………………………………. approve of
and authorise this application to Forte.
Name
E-mail address
Signature
Date
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ANNEXURES
Please attach the following as annexures to the application and list additional annexures, where applicable:
i.
ii.
iii.
iv.
The project budget in Microsoft Excel
CVs of the Principal Investigators including a list of publications/patents over the past 3 years
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