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UPM/TNCPI/RMC/P02/SKBL/BR5
PEJABAT TIMBALAN NAIB CANSELOR Untuk kegunaan pejabat
(PENYELIDIKAN DAN INOVASI) sahaja / For office use only
OFFICE OF THE DEPUTY VICE CHANCELLOR Ruj. Fail /
(RESEARCH AND INNOVATION) File Ref:
Kod Projek /
Project Code:
PUSAT PENGURUSAN PENYELIDIKAN
(RESEARCH MANAGEMENT CENTRE)
Tel: 603-89471604 Faks: 603-89471634
http://www.rmc.upm.edu.my
BORANG PERMOHONAN HADIRI SEMINAR / KONFERENSI / BENGKEL /
LAWATAN LUAR NEGARA (PERUNTUKAN GERAN PENYELIDIKAN)
APPLICATION FORM TO ATTEND OVERSEAS SEMINAR / CONFERENCE / WORKSHOP /
VISIT (RESEARCH GRANT ALLOCATION)
(Penting: Sila rujuk Senarai Semak dan mengikuti arahan sebelum mengisi borang ini)
(Important: Please refer to the Checklist and follow the instruction before filling in this form)
1. Nama / Name :
( Prof. / Prof. Madya / Dato’/ Datin /Dr. / Encik / Puan )
No. Kakitangan / *Tarikh Lantikan /
2. Jawatan /
Staff No. : Date of
Position :
Appointment:
Gaji Pokok & Gred Gaji /
Taraf Perkhidmatan / Tetap / Kontrak* /
3. Basic Salary &
Status of Service: Permanent / Contract*
Salary Grade :
No. Telefon / No. Tel. Bimbit / E-mel /
4.
Telephone No. : Handphone Tel. No. : Email :
Nama Geran / No. Vot /
5. UPM Vote
Name of Grant:
No. :
6. Jabatan /
Department :
7. Fakulti / Faculty :
Tarikh Seminar / Konferensi / Bengkel / Lawatan* /
8.
Date of Seminar / Conference / Workshop / Visit*:
Tempat diadakan /
9.
Venue :
Tajuk Seminar / Konferensi / Bengkel / Lawatan* /
10.
Name of Seminar / Conference / Bengkel / Visit*:
Penganjur /
11.
Organiser :
12.
Penyertaan Sebagai / Pembentang Kertas Kerja / Ahli Panel Pengambil Bahagian
Participation As : Paper Presenter Panelist Participant
No. Semakan : 05 1/ 11
No. Isu : 01
Tarikh Kuat kuasa : 01/04/2010
UPM/TNCPI/RMC/P02/SKBL/BR5
Tajuk Kertas Kerja /
13.
Title of Paper :
(Sila lengkapkan Abstrak Kertas Kerja mengikut format yang disediakan)
(Please complete Abstract of Paper according to the prepared format)
*Bagi pegawai kontrak, tarikh lantikan adalah tarikh mula berkhidmat di UPM / For contract staff, date of
appointment is the date of service in UPM.
14. Seminar / Konferensi / Bengkel / Lawatan di luar negara yang telah dihadiri dalam masa dua (2) tahun /
Overseas Seminar / Conference / Workshop / Visit attended within two (2) years :
Bantuan- Vot . Geran yang
Tajuk Seminar / Konferensi / Tempat Jumlah bantuan Lain digunakan
Tarikh Lawatan Venue Daripada UPM Yang Diterima Grant Vote
Date Name of Seminar / Conference / Total From Other Forms of already Utilised
Visit UPM Assistance
Received
15. Hasil penyelidikan yang telah diterbitkan dalam Jurnal* / Paten yang sedang menunggu keputusan / Buku
ilmiah / Bab dalam buku ilmiah / Anugerah peringkat Nasional & Antarabangsa dalam tempoh tiga (3)
tahun yang lepas (sertakan tiga (3) abstrak jurnal terkini sebanyak sepuluh (10) salinan).
Research output which has been published in Journal* / Patent pending / Scholarly book / Chapter in
scholarly book / Award at National & International levels within the least three (3) years (please attach
three (3) latest journal abstracts in ten (10) copies).
Bil . Hasil Penerbitan (Pengarang, Tajuk, Jurnal, Jilid, Mukasurat) Tahun
No. Publication (Author, Title, Journal, Volume, Page Number) Year
*Sekurang-kurangnya satu (1) jurnal penyelidikan (wajib) serta dua (2) hasil penyelidikan yang lain.
*At least one (1) (compulsory) research journal including two (2) other research output.
16. Nyatakan bantuan kewangan yang diminta secara terperinci. Sekiranya menggunakan geran penyelidikan,
nyatakan sumber, nombor Vot dan baki geran yang sedia ada.
Please provide details of financial assistance requested. If using research grant, please provide details of
the resource, Vote number and balance of existing grant.
No. Semakan : 05 2/ 11
No. Isu : 01
Tarikh Kuat kuasa : 01/04/2010
UPM/TNCPI/RMC/P02/SKBL/BR5
Jumlah Dipohon (RM) /
Perkara / Item
Total of Request (RM)
a) Tambang / Fare
i. kapal terbang / flight
ii. pengangkutan internal /
internal transport
b) Makan (RM x hari) /
Food (RM x days)
c) Penginapan (RM x hari) /
Lodging (RM x days)
d) Yuran /Fee
JUMLAH BESAR (RM) /
OVERALL TOTAL
Baki J500/ Baki J900/
MAKLUMAT GERAN / V21000 (RM) V29000 (RM)
GRANT INFORMATION Balance of Balance of
J900/V29000 (RM)
J500/V21000 (RM)
Jumlah Geran Diluluskan
(RM) /
Total of Approved Grant
(RM)
Baki Terkini Geran
(RM) /
Latest Balance of Grant
(RM)
Ulasan daripada Zon Kewangan, Bendahari /
Remarks by Finance Zone, Treasury
*Baki siri J500/V21000 dan J900/V29000 /
Total of Balance Series J500/21000 and J900/29000
Mencukupi Tidak Mencukupi
Enough Not Enough
Disahkan oleh / Certified by :-
___________________________________
(Tandatangan & Cap Rasmi) /
(Signature & Offical Stamp)
17. Permohonan melakukan pemindahan Siri-J / Application for Series-J transaction:
Pernah Belum pernah
Have Done Have Not Done
No. Semakan : 05 3/ 11
No. Isu : 01
Tarikh Kuat kuasa : 01/04/2010
UPM/TNCPI/RMC/P02/SKBL/BR5
18. Bantuan daripada Penganjur lain (Nyatakan jenis bantuan dan jumlah) /
Assistamce from other Sponsors (Please provide details of assistance and total):
19. Saya bersetuju / tidak bersetuju* permohonan dimajukan ke Bahagian Akademik untuk mendapatkan
kelulusan menggunakan peruntukan UPM sekiranya baki tidak mencukupi / pemohon tidak layak
menggunakan peruntukan geran penyelidikan. (Permohonan adalah tertakluk kepada syarat yang
ditetapkan oleh Jawatankuasa Seminar / Konferensi / Bengkel).
I agree / disagree* that this application is to be forwarded to the Academic Division in order to obtain
approval for using UPM allocation if the balance is not enough / applicant is not eligible for research grant
allocation. (Application is subject to conditions authorised by the Seminar / Conference / Workshop
Committee).
(*Catatan: Kadar perbelanjaan di bawah hanya perlu diisi oleh pemohon yang tidak layak menggunakan
peruntukan geran penyelidikan atau pemohon yang memerlukan peruntukan tambahan daripada
Jawatankuasa Seminar / Konferensi / Bengkel).
(*Note: The expense rates below should only be filled in for applicants who are not eligible for research
grant allocation or applicants who need additional allocation from the Seminar / Conference / Workshop
Committee).
Tambang Pengangkutan Makan Penginapan Yuran Jumlah Besar
udara internal
Flight Fare Internal
transport Food Lodging Fee Overall Total
RM RM RM RM RM RM
20. Terangkan perlunya anda menghadiri Seminar / Konferensi / Bengkel / Lawatan ini /
Please justify why you need to attend this Seminar / Conference / Workshop:
Tarikh Mohon / Tandatangan Pemohon /
Application Date: _____________________ Applicant Signature: _________________________
(PENTING: Sekiranya anda merupakan penyelidik bersama bagi geran peruntukan ini, sila dapatkan
cap pengesahan daripada Ketua Projek).
(IMPORTANT: If you are the co-researcher for this allocation grant, please obtain stamp of
certification from Head of Project).
ULASAN DAN PENGESAHAN KETUA PROJEK
REMARKS AND CERTIFICATION BY HEAD OF PROJECT
a) Ulasan dan pengesahan Ketua Projek / Remarks and certification by Head of Project:
______________________________________________________________________________________
______________________________________________________________________________________
Tarikh / Tandatangan dan Cap Jawatan /
Date : _____________________ Signature and Stamp of Position: _________________________
No. Semakan : 05 4/ 11
No. Isu : 01
Tarikh Kuat kuasa : 01/04/2010
UPM/TNCPI/RMC/P02/SKBL/BR5
ULASAN JABATAN / BAHAGIAN
REMARKS BY DEPARTMENT / DIVISION
b) Ulasan Ketua Jabatan / Remarks by Head of Department:
____________________________________________________________________________________
____________________________________________________________________________________
Tarikh / Tandatangan dan Cap Jawatan /
Date: ____________________ Signature and Stamp of Position: __________________________
ULASAN TIMBALAN DEKAN (PENYELIDIKAN) / KETUA MAKMAL
REMARKS BY THE DEPUTY DEAN (RESEARCH) / HEAD OF LABORATORY
c) Ulasan Timbalan Dekan (Penyelidikan) / Ketua Makmal / Remarks by the Deputy Dean (Research) / Head
of Laboratory:
___________________________________________________________________________________
____________________________________________________________________________________
Tarikh / Tandatangan dan Cap Jawatan /
Date: ____________________ Signature and Stamp of Position: __________________________
PENGESAHAN KETUA PTJ
CERTIFICATION BY HEAD OF RESPONSIBILITY CENTRE
d) Ulasan dan pengesahan Ketua PTJ / Remarks and certification by the Head of Responsibility Centre :
____________________________________________________________________________________
____________________________________________________________________________________
Tarikh / Tandatangan dan Cap Jawatan /
Date: ____________________ Signature and Stamp of Position: __________________________
No. Semakan : 05 5/ 11
No. Isu : 01
Tarikh Kuat kuasa : 01/04/2010
UPM/TNCPI/RMC/P02/SKBL/BR5
SENARAI SEMAK
BORANG PERMOHONAN MEMBUAT PERJALANAN KE LUAR NEGARA
DENGAN MENGGUNAKAN PERUNTUKAN GERAN PENYELIDIKAN
CHECKLIST
APPLICATION FORM FOR OVERSEAS JOURNEY
USING RESEARCH GRANT ALLOCATION
Nama Pemohon /
Name of Applicant : _____________________________________________________
PTJ / Jabatan /
Responsibility Centre / Department :
_______________________________________________________________________
Sila tandakan ” √ ” (jika ada) dan ”X” (jika tiada / tidak berkenaan)
Please mark ” √ ” (if in possession) and ”X” (if not in possession / not applicable)
1. Tempoh permohonan dikemukakan enam (6) minggu sebelum acara
(selewatnya-lewatnya 12hb pada bulan tersebut)
Application submitted within a period of six (6) weeks before event
(at least on the 12th of that particular month)
2. Taraf perkhidmatan pegawai:Tetap / Kontrak**
Officer level of service: Permanent / Contract**
3. Nyatakan jenis acara yang dihadiri:
Seminar / Konferensi / Kongres / Bengkel / Lawatan**
Please provide type of event going to be attended:
Seminar / Conference / Congress / Workshop / Visit**
4. Bilangan hari yang dipohon : hari
Number of days applied: _______ days
5. Sebagai pembentang kertas kerja
As paper presenter
6. Maklumat jurnal dilengkapkan
Information of journal which has been completed
7. Penerbitan / anugerah selain daripada jurnal, sekiranya ada
(sebagai contoh: paten, paten yang sedang menunggu keputusan,
bab dalam buku ilmiah dan lain-lain) dilengkapkan
Publication / award apart from journal, if applicable
(i. e. patent, patent pending, chapter in scholarly book and others)
which has been completed
8. Sila lengkapkan Borang Maklumat Harta Intelek / Kindly fill up the
Intellectual Property Information Form
No. Semakan : 05 6/ 11
No. Isu : 01
Tarikh Kuat kuasa : 01/04/2010
UPM/TNCPI/RMC/P02/SKBL/BR5
9. Pengesahan daripada Zon Kewangan, Bendahari dan Penyata Kewangan
diperolehi dengan lengkap
Certification from the Finance Zone, Treasury and Financial Statement
which have been obtained in full
10. Surat penerimaan kertas kerja / kebenaran lawatan ada disertakan
Letter of paper acceptance / permission to visit has been attached
11. Abstrak disertakan
Abstract attached
12. Brosur seminar / konferensi/ bengkel disertakan atau lain-lain dokumen yang
berkenaan / jadual lawatan disertakan
Brochure of seminar / conference / workshop attached or other relevant
documents / schedule of visit attached
13. Ulasan Ketua Jabatan / Dekan / Pengarah
Remarks by the Head of Department / Dean / Director
14. Salinan borang sebanyak sepuluh (10) salinan
Ten (10) copies of application form
Tandatangan
Signature :
Tarikh
Date :
No. Semakan : 05 7/ 11
No. Isu : 01
Tarikh Kuat kuasa : 01/04/2010
UPM/TNCPI/RMC/P02/SKBL/BR5
MAKLUMAT PENTING / IMPORTANT INFORMATION :
1. Sila hantar sepuluh (10) salinan borang ini dengan lengkap termasuk menyertakan brosur
seminar, surat Penerimaan kertas kerja, abstrak kertas kerja dan penyata Penyata
Kewangan Lengkap.
Please submit ten (10) completed copies of this application form including attaching the
seminar brochure, letter of paper acceptance, abstract of paper and statement of Budget
Transaction Detail.
2. Setiap permohonan perlu dihantar selewat-lewatnya 2 hari bekerja sebelum mesyuarat
JKKSKBL setiap bulan untuk diproses pada bulan tersebut. Sekiranya lewat, borang
tersebut akan diproses pada bulan berikutnya.
Every application must be submitted at least 2 days before the JKKSKBL meeting every
month in order to be processed in that particular month. If submitted later than the date, the
form will be processed in the following month.
3. Borang permohonan hendaklah dihantar ke Pusat Pengurusan Penyelidikan (RMC), UPM-
MTDC, UPM Serdang selewat-lewatnya enam (6) minggu sebelum tarikh seminar/
konferensi/ bengkel/ lawatan.
The application form must be submitted to the Research Management Centre (RMC),
UPM-MTDC, UPM Serdang at least six (6) weeks before the date of the seminar /
conference / workshop / visit.
4. Sila sertakan Penyata Kewangan Lengkap terkini dari pihak Bendahari dan disahkan oleh
pegawai berkenaan.
Please attach latest Budget Transaction Detail from the Treasurer and certified by the
respective officer.
5. Pihak Jawatankuasa Kerja Seminar / Konferensi / Bengkel / Lawatan (JKK SKBL) ke Luar
Negara Menggunakan Geran Penyelidikan hanya akan meluluskan jumlah setakat baki
mengikut Siri-J geran penyelidikan tersebut dan tidak akan bertanggungjawab sekiranya
tuntutan melebihi baki Siri-J geran penyelidikan.
The Working Committee of the Seminar / Conference / Workshop / Visit (JKK SKBL) to
Overseas Using Research Grant will only approve the remaining total of balance according
to the respective Series-J research grant and will not be responsible if the claim is more
than the balance of the Series-J research grant.
6. Adalah menjadi tanggungjawab pemohon untuk memohon sendiri pada pihak universiti
melalui Jawatankuasa Seminar / Konferensi / Bengkel (JKK SKW) bagi menampung
jumlah perbelanjaan yang tidak mencukupi (jika berkaitan).
It is the responsibility of the applicant to appy himself/herself to the university through the
Committee of the Seminar / Conference / Workshop (JKK SKW) in order to absorb
additional total of expediture (if applicable).
No. Semakan : 05 8/ 11
No. Isu : 01
Tarikh Kuat kuasa : 01/04/2010
UPM/TNCPI/RMC/P02/SKBL/BR5
7. Sebarang maklumat lanjut, sila hubungi:
Urusetia JKK SKBL
Unit Pengurusan Am dan Khidmat Korporat
Pusat Pengurusan Penyelidikan
UPM-MTDC,
Universiti Putra Malaysia, Serdang
Pegawai : Pn. Nor Khirma Amie bt Safiee
Telefon : 603-89471606
Faks : -
Emel : ima@rmc.upm.edu.my
Atau
Urusetia JKK SKW
Bahagian Akademik
Tingkat 1, Bangunan Pentadbiran
Universiti Putra Malaysia, Serdang
Pegawai : Pn. Normala Osman
Telefon : 603-89466051
Faks : 603- 89426469
Emel : normala@putra.upm.edu.my
For further details, please contact:
The JKK SKBL Committee
The Administration and Support Unit
Research Management Centre
UPM-MTDC,
Universiti Putra Malaysia, Serdang
Officer : Mrs. Nor Khirma Amie bt Safiee
Telephone : 603-89471606
Fax : -
Email : ima@rmc.upm.edu.my
OR
The JKK SKW Committee
Academic Divsion
First Floor, Administration Building
Universiti Putra Malaysia, Serdang
Officer : Mrs. Normala Osman
Telephone : 603-89466051
Fax : 603- 89426469
Email : normala@putra.upm.edu.my
No. Semakan : 05 9/ 11
No. Isu : 01
Tarikh Kuat kuasa : 01/04/2010
UPM/TNCPI/RMC/P02/SKBL/BR5
==================================================================
CONTOH FORMAT PENYEDIAAN ABSTRAK KERTAS KERJA
EXAMPLE OF FORMAT FOR PREPARATION OF ABSTRACT OF PAPER
=====================================================================
Title: Investigating the neuroprotective effects of inducing HSP70 expression in the kainic
acid model of neurotoxicity
Author: Vidyadaran S
Department/Faculty: Department of Pathology, Faculty of Medicine and Health Sciences
Aim: The aim of this study was to determine the cytoprotective effects of geranylgeranylacetone
(GGA) in transgenic mice overexpressing heat shock protein (HSP) 27. Previously, we have
demonstrated that HSP27 transgenic mice are protected from kainic acid (KA)-induced cell death in
the hippocampus. To determine if inducing HSP70 expression in our HSP27 transgenic mice could
confer even greater protection against KA, we used the antiulcer drug, GGA to increase HSP70
levels in the hippocampus (this section of the work carried out at Department of Cellular &
Molecular Neuroscience, Imperial College London).
Methodology: Fresh frozen brain samples from GGA-treated mice killed at 7 days post-KA
administration were collected, stained with haematoxylin and eosin (H&E) and analysed for
neuronal cell density. Four geometrical Area of Interests (AOIs) were placed in CA1, CA2 and
CA3 (arc and hilus) regions of the hippocampus. The total number of neurones within each AOI
was enumerated. The reliability of the cell quantification was determined by performing repeated
counts on a single brain section.
Results: Counts for all four AOIs showed low standard deviation (SD), indicating low variability.
Cell counts were also performed on images that were manipulated for maximum contrast.
Variations within regions, as determined by SD were lower in maximum contrast images compared
to regular images for hilus, CA2 and CA1 but not arc region. All further counts were conducted on
maximum contrast images. HSP27 transgenic mice treated with GGA showed no significant
difference (p>0.05) in cell count following treatment with KA in any of the AOIs. This indicates
that the constitutive expression of the HSP27 transgene is sufficient to provide neuroprotection
following KA treatment.
Conclusion and future work: It is concluded that the HSP70 induction by GGA does not confer
greater protection to HSP27 transgenic mice following KA. Future work should examine the
possibility of developing double transgenic mice (HSP27 X HSP70) to determine the
neuroprotective effects of constitutively expressing both these HSPs.
Key words: HSP, kainic acid, hippocampus, geranylgeranylacetone
No. Semakan : 05 10/ 11
No. Isu : 01
Tarikh Kuat kuasa : 01/04/2010
UPM/TNCPI/RMC/P02/SKBL/BR5
MAKLUMAT PENTING
PERLINDUNGAN HARTA INTELEK
NAMA : _____________________________________________
PTJ / JABATAN : _____________________________________________
NO. TEL / HP : _____________________________________________
E-MEL : _____________________________________________
1. Sudahkah anda memohon untuk membuat perlindungan Harta Intelek untuk hasil
penyelidikan ini?
Sudah Belum
2. Jika jawapan pada soalan 1 adalah belum, adakah rundingan telah dilakukan antara anda dan
pihak ICC?
Sudah Belum
Jika sudah, nyatakan tarikh: _________________________________
3. Jika jawapan anda pada soalan 1 adalah sudah, sila nyatakan maklumat pemfailan.
Nyatakan PI No.: __________________________________
Tarikh : ____________________ Tandatangan : ____________________
No. Semakan : 05 11/ 11
No. Isu : 01
Tarikh Kuat kuasa : 01/04/2010
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