RESEARCH GRANT APPLICATION FORM

Please read the PERI Research Grant Guideline carefully prior to completing the application!

1. Name of principal investigator: ......................................................

2. Name of co-investigator:

a. ......................................................

b. ......................................................

c. ......................................................

(please add when necessary)

3. Title of Project: ..........................................................................................................

...................................................................................................................................

...................................................................................................................................

4. Summary of proposal (< 200 words):

The Prodia Education and Research InstituteProdia Tower 9 Floor, Jl. Kramat Raya No.150, Jakarta Pusat 10430, Indonesia Phone: +62-21-3144182 ext:3872, Fax : +621-21-3144181E-mail: [email protected]

5. Project starting date, duration and timeline:

6. Fill in the table below regarding category of test and expense to be funded.

..............., DD/MM/YYYY

Principal Investigator,

(Full Name)

Category of Test Expense