附件一%20千里马计划项目申请表20180715docx.docx

1、30 June 2018 Page 1of 9 Circulation restricted to the Administration Office of THEKEY Scientific Research Fund and to the author of the document to protect the individual and to protect privacy, commercial and industrial secrecy APPLICATION FOR THE PROJECTS OF THE RACING PLAN THEKEY SCIENTIFIC RESEA

2、RCH FUND 关键科学研究基金千里马计划申请书范本 Please supply one signed application. All data included in this application must concern only the legal entity or entities making the application. 1 SUBMITTED by 申请依托机构 Name(s) of legal entity or entities making this application 申请依托机构名称 Nationality 国籍 Leader 领导机构 Member

3、成员机构 Etc 2 CONTACT PERSON (for this application) 联系人 Name 姓名 Organization 机构名称 Address 地址 Telephone 电话 Fax 传真 e-mail 电子邮件 15 January 2016 Page 2 of 9 3 GENERAL INFORMATION OF THE PROJECT 项目描述 A. General Information (max. 1 page) 项目基本信息 A.1. Project Title (max. 15 words) 项目名称 （不超 15字） A.2. Thematic a

4、reas for the project (single or multiple choice) 项目所属领域 A.3. Indicative total project cost 项目申请金额 Amount: USD CNY A.4. Any co-financing 是否有其他来源资金共同投入 Yes No 是 否 A.5. Estimated project duration 估计项目时长 Half year One year months 半年 一年 个月 B. Project description (max. 2 pages) 项目描述 （不超过 2 页） Description

5、of the current research trend in the field Description of the research project including objectives, background, merits and importance of the project, scientific issues targeted, proposed methodologies applicable Main research activities of the key members Description of the existing collaboration,

6、the necessity of proposed collaboration, and collaborative arrangements defining general responsibilities and tasks assigned to each side in order to realize the project goals Description of planned workshops or symposia if any 描述本领域内的发展趋势； 描述本研究项目：目标，背景，项目的优点和重要性，针对的科学议题，准备采用的方法； 核心成员的主要研究活动； 对现有中外

7、合作的描述、建议的中外协作的必要性和合作安排，为实现项目目标而做出的双方合作安排：各方的责任和分工； 如果在项目中计划了研讨会或论坛，请进行描述。 30 June 2018 Page 3 of 9 4 THE WORK PLAN 工作计划 Month 月份 1 2 3 4 5 6 7 8 9 10 11 12 Activities 工作内容 30 June 2018 Page 4 of 9 5 BUDGET ESTIMATION 估计预算 5.1 Chinese Side 中方申请人 Month 月份 1 2 3 4 5 6 7 8 9 10 11 12 Research Cost 研究费用

8、Equipment/Instrument 仪器设备 Seminar/Workshop Cost 研讨会费用 Travels 旅行访问 Others 其他 Total 总计 30 June 2018 Page 5 of 9 5.2 International Side 国际合作方 Month 月份 1 2 3 4 5 6 7 8 9 10 11 12 Research Cost 研究费用 Equipment/Instrument 仪器设备 Seminar/Workshop Cost 研讨会费用 Travels 旅行访问 Others 其他 Total 总计 5.3 Total Amount 项目

9、总金额 Total Amount Applied for from THEKEY Fund: 向关键基金申请的项目金额总计： Total Amount from Other Sources: 项目其他资金来源合计： 30 June 2018 Page 6of 9 6. APPLICANT INFORMATION 申请人信息 6.1 Chinese Side 中方申请人 Position in The Project 项目中担任职务 Name 姓名 Degree 学历 Research Area 研究领域 Academic Title 职称 Institution 机构 Address 地址 E

10、-Mail 电子邮件 Tel. 电话： Fax: 传真： Project Experiences 项目经验 Expertise 专长 Related Scientific Publications in the last 5 years （ up to 10) 过去五年的主要发表的相关论文及出版物 （不超过 10篇） 30 June 2018 Page 7of 9 6.2 International Side 国际申请人 Position in The Project 项目中担任职务 Name 姓名 Degree 学历 Research Area 研究领域 Academic Title 职称

11、Institution 机构 Address 地址 F-Mail 电子邮件 Tel. 电话： Fax: 传真： Project Experiences 项目经验 Expertise 专长 Related Scientific Publications in the last 5 years （ up to 10) 过去五年的主要发表的相关论文及出版物 （不超过 10篇） 30 June 2018 Page 8of 9 6.3 Other Members 其他成员 Position in The Project 项目中担任职务 Name 姓名 Degree 学历 Research Area 研究

12、领域 Academic Title 职称 Institution 机构 Address 地址 G-Mail 电子邮件 Tel. 电话： Fax: 传真： Project Experiences 项目经验 Expertise 专长 Related Scientific Publications in the last 5 years （ up to 10) 过去五年的主要发表的相关论文及出版物 （不超过 10篇） 7. SIGNATURES 签字 Chinese Applicant International Cooperative Side 中方申请人 国际合作方 Signature 签字 S

13、ignature 签字 Name 姓名 Name 姓名 Date 日期 Date 日期 Page 9of 9 FORMAT FOR EXPRESSIONS OF INTERESTS 项目意向书范本 Your ref: Dear Sir/Madam In response to your Call for Expressions of Interests, we, , submit the application form. We assure the information we have presented in this Expressions of Interests and the a

14、pplication form and its appendices is true and correct. We hereby declare that: We have examined the Call for Expressions of Interests. If our application is short-listed, we fully intend to submit a full project proposal according to your requirements. We are fully aware that, for a consortium, the

15、 composition of the consortium cannot be changed in the course of the fund application procedure, unless the Administration Office has given its prior approval in writing. We are aware that, for the purposes of evaluation, our personal data may be transferred to the Fund internal offices and the evaluation panel. Yours faithfully,