APPLICATION FOR PREVEST CLINICAL RESEARCH AWARD
 
Information for Applicants
PRI strongly suggests that the applicant and her/his mentor use the evaluation form to perform a self-evaluation of the case report prior to submitting it for review. Comments on commonly identified problems are included as examples below; however, this is not an all-inclusive list of problems identified in case reports by the peer reveiw Committee.
Primary Applicant
Applicant Name
Tile First Name Surname
 
Qualification  
Practice Type  
Institution (If Applicable)
Department (If Applicable)
Street Address  
 
City State Pincode
       
E-Mail Id    
Contact Nos.
Phone(Work) Phone(Home) Mobile
       
Please Indicate if this applicant is in one of the following categories:
If Student, Name of the Research Supervisor
Is administration of the grant And correspondence the responsibility of this Applicant?    
Dental Discipline  
Case Report Title  
Date of Publication (Date Format:DD-MM-YYYY)    
Name of the Journal  
Pubmed Indexing  
Impact Factor  
Browse Copy of the Publication    (Only jpg or doc or docx or pdf File Formats)