THE PROJECT REQUEST FORM		           Annex Nr. 3. 1. A. / EN
VV-2019-P1-EN	Basic information about the project	
01	Project ID	(To be completed by the Ministry of Health.)	
02	Project Title		
03	Acronym of the Project	(Maximum 10 characters.)	
04	Supported priority areas chosen 
from the approved list for a current year	(List of priorities and supported areas of R&D in a domain of health in the Slovak Republic for 2019 as a part of the Call for to be submitted research grant applications.)	
05	Lay Summary	(Up to 150 words, unless stated otherwise, this section will be published.)	
06	Objectives of the Proposed Project	(Up to 100 words, to be named in points.)	
08	Applicant	(The organization responsible for the solution as well as the administrative enforcement of the project)	
09	Principal Investigator	(Expert of the research grant applicant organization, responsible for the project management, project guarantee.)	
10	Required Budget from the Ministry 
of Health (in EUR)	(Amount of grant requested from the state budget.)	
11	Co-financing from other Resources 
(in EUR)	(Amount of co-financing from other resources.)	
12	Total Project Budget (in EUR)	(Total amount (state budget + other resources of funding.)	

VV-2019-P2.1-EN	Basic information about participating organization	
Applicant	
01	Name of the organization		
02	Address of the Organization		
03	Organization Identification Number		
04	Legal form of the Organization		
05	Sector		
06	VAT Payer		
07	Financial Project Manager	 (Person of the applicant for the research grant who is responsible for the financial part of the project.)	
	Phone		
	E-mail		
08	Authorized Person to sign the Contract on behalf of the Applicant	(To be completed even if the person is identical to the applicant's statutory representative.)	
	Phone		
	E-mail		

VV-2019-P2.2-EN	Basic information about the principal investigator	
01	Name and Surname, Title		
02	Funkcion; Position		
03	Phone		
	E-mail		
04	Employer		
	Address		
	Phone		
	E-mail		
05	Professional Specialisation		
06	 The most significant publications 
during last 5 years, or ID of researcher	(Please include in which of two of the listed databases the publications are available:  Databases Institute of Scientific Information (ISI ) or PubMed (Medline). Please do not refer to other databases. Please include by whom and where the publication has been citated. Explicitly provide citations in the  Science Citation Index (SCI), Thomson Scientific Databases Institute of Scientific Information. In case, that your publications are not listed in the SCI, please provide the reasoning.	
07	List of projects of the principal investigator in R&D in the domain of health 	(As regard of each project, it is necessary to mention the principal investigator, title of the project and the project number, name of the financing organization, grant amount, actual results achieved, date of implementation.)	
08	Number – Projects of the principal investigator executed during the last 
5 years		
09	Total number of citations in SCI / ISI database	

VV-2019-P2.3-EN	Basic information about co-operative organization	
Cooperating organization	
01	Name of the Organization		
02	Adress of the Organization		
03	Organization Identification Number		
04	Legal form of the Organization		
05	Sector		
06	VAT Payer		
07	Authorized person to sign the Contract on behalf of the Applicant for reserach grant		
	Phone		
	E-mail		

V-2019-P2.4.1-EN	List of Participants	
01 	List of staff directly involved in the Project	
Name and Surname	Titles	Job / Position	Organization Identification Number	Hours	

					

					

VV-2019-P2.4.2-EN	List of Participants	
02	Other staff	Total number of other staff		
		Total capacity of other staff in hours		
03	In total	Total number of the employed staff		
		Total capacity of the employed staff in hours		

VV-2019-P2.5-EN	Project Manager / Project Leader
(Contact person, other than the principal investigator, authorized 
by the statutory representative to conduct the administrative management of the project 
on behalf of the applicant.)	
01	Name and Surname, Titles		
	Phone		
	Email		

VV-2018-P2.6-EN	Existing Infrastructure
(Please, describe the existing infrastructure, in details, by listing all the organizations involved in the project work.)