Details of the Institution (institute, faculty, or university)

Name of the Institution:

Address:

Title of the Proposal:

The objectives of the research proposal in accordance to the research plan of the institution as well as the benefits to Egypt

Data of the Applicant

Name:

Title:

Tel/Mobile:

Fax:

E-mail:

Roles and Responsibilities of the Applicant in the Institution (Academic, research, Administration, etc.)

Date:

Signature:

Details of the Legal Representative (Head of the institution, Dean of the Faculty or President of the university)

Name:

Title:

Tel:

Fax:

Email:

Date:

Signature:

Official Signature & Stamp of the Institution