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| Address:
_________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
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| DETAILS OF
PROJECT |
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| Name of Project: _________________________________________________________________________ |
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| _________________________________________________________________________________________ |
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| Duration of Project:
_______________________________________________________________________ |
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| Estimated Cost :
__________________________________________________________________________ |
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| FIELD: (Please Circle or
Tick) |
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| 1.) Screening
2.) Detection 3.)
Prevention 4.) Treatment |
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| 5.) Any Other Please Mention: _______________________________________________________________ |
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| Aims:
___________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
| |
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| Objectives:
______________________________________________________________________________ |
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| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
| |
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| Methodology:
____________________________________________________________________________ |
| |
| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
| |
| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
| |
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| References:
______________________________________________________________________________ |
| |
| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
| |
| _________________________________________________________________________________________ |
| |
| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
| |
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| Potential Benefits & Relevance
to
Cancer:___________________________________________________ |
| |
| _________________________________________________________________________________________ |
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| _________________________________________________________________________________________ |
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| |
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|
| _______________________________ |
______________________ |
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|
| Signature & Stamp of the
Head of the Institution |
Signature |
|
| |
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| _________________________________________________________________________________________ |
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Note: Completed application form
should be sent along with a demand draft of
Rs. 2000/- in
the name of Cancer Aid & Research Foundation at the above
address
Kindly send along all supporting documents to
enhance your project. |
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