CANSA Type A Grant Funding Programme

Please note
All information within or accompanying this document is regarded as confidential and will be treated as such in terms of the Protection of Personal Information Act No 14 of 2013.
Project Title*
Investigators
Principal Investigator*
Qualifications/Degrees*
University Affiliation*
Principal Investigator Email Address*
Principal Investigator Phone Number*
Co-investigator 1
Qualifications/Degrees
University Affiliation
Co-investigator 1 Email Address
Co-investigator 1 Phone Number
Co-investigator 2
Qualifications/Degrees
University Affiliation
Co-investigator 2 Email Address
Co-investigator 2 Phone Number
Co-investigator 3
Qualifications/Degrees
University Affiliation
Co-investigator 3 Email Address
Co-investigator 3 Phone Number

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Study Synopsis (Max 1050 characters)*
Background and Rationale for the Study (Max 1350 characters)*
Preliminary Data on the Proposed Project (Max 550 characters)*
This may include data from smaller related projects conducted to evaluate and or demonstrate the feasibility and potential impact of the project. Preliminary data included may be the result of prior research conducted by the applicant or collaborators on this application. It may include quantitative or qualitative data. Please reference these studies in your reference list.
1. Winchester CL, Salji MJ, Kasivisvanathan V. Gathering preliminary data. J Clin Urol. 2017;10(6):568–72.
2. National Institute of Allergy & Infectious Diseases. Strengthen Your Application With Preliminary Research [Internet]. 2020. Available here

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Applicant CV / Bio-sketch Template
Applicants full Name and Title*
Correspondence Address*
Street Address Address Line 2 City Province Postal Code
Phone Number (W)*
Cell Number*
Email*
University / Institution / Hospital*
Department/Section
Present Position*
Date of Birth*
MM slash DD slash YYYY
Nationality*
Positions Held During the Past 10 years*
Please name the institution(s) and dates
Identity Number*
South African residency status*
If you are not a S.A. citizen, a copy of your residency permit is to be attached to this application.
- Permanent
- Temporary
Qualifications*
Please name where it was obtained and the dates
Distinctions Awards
Please name where it was obtained and the dates
Grants Held in the Last 5 Years and Position on the Grant (eg Principal Investigator).

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Publication Record
Number of Peer-reviewed Publications to Date
Number of Peer Reviewed Publications in Past 5 Years
Number of Books to Date
Number of Chapters in Books to Date
Number of Patents to Date
Please list your most relevant publications (maximum of 5) concerning the current proposal (title, authors, journal, date, volume, page numbers)
SA Residency Permit
If you are not a S.A. citizen, please attach a copy of your residency permit here.
Max. file size: 10 MB.
Comments
This field is for validation purposes and should be left unchanged.

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Investigators