ISERC Research Request Form

Please make sure that ALL of the items below have been fulfilled. The KH ISERC Committee will NOT be able to review your proposal until all these items are completed.

1. For a research project that is NOT a thesis or an academic requirement:
   • Research Request Form filled completely
   • Study proposal/protocol including relevant appendices e.g., questionnaires, consent forms, conflict-of-interest, etc.
   • Required CVs attached
   • Materials submitted in soft copy (Word documents)
   • LOCAL (Kijabe Hospital) research supervisor in addition to the external supervisor. This can be any senior person in the respective department who has previous research experience.
2. For a research project that is a thesis or an academic requirement:
   • Research Request Form filled completely
   • Required CVs, questionnaires, consent forms, etc., attached
   • Study proposal/protocol and/or thesis proposal/protocol including relevant appendices submitted in soft copy
   • The proposal MUST include the following headings:
     • Literature review (if needed for academic requirement)
     • Study aim and specific objectives
     • Methodology, including design, sampling, and detailed statistical analysis
     • Ethical considerations, including informed consent, confidentiality, anonymity
     • Timeline and expenses
     • Population
     • References/Bibliography (if needed for academic requirement)
     • Any questionnaires used (required!)
     • Consent form in plain (Grade 5) English and Kiswahili
   • LOCAL (Kijabe Hospital) research supervisor in addition to the external supervisor. This can be any senior person in the respective department who has previous research experience.
   • TIMELINE: Please note that the KH ISERC Committee needs on average one-month advance notice before a decision is made. DO NOT schedule your project to start less than one month after the completed proposal is submitted!
3. All authors/principal investigators MUST send proof of the following trainings before receiving the official approval letter:
   • Good Clinical Practice
   • Data Protection
4. Study proposal/protocol review charges by KH ISERC:

   Applicant Category	Kijabe Internal Applicant	External Applicant
   Diploma-level student	KES 500	KES 2,000
   Degree-level student	KES 1,000	KES 5,000
   Master-Level student	KES 1,500	KES 7,500
   PhD level student	KES 2,000	KES 10,000
   Researcher/Consultant studies	KES 2,000	KES 10,000
   Collaborative studies	KES 10,000	KES 20,000
   KH Nursing school	Annual institutional review of KES 10,000

5. Payment Details:
   • MPESA PAYBILL NUMBER
   • Business Number: 512900
   • Account Number: 013-09