KLE ACADEMY OF HIGHER EDUCATION AND RESEARCH

( KLE UNIVERSITY’S ) KLE VK INSTITUTE OF DENTAL SCIENCES,

BELAGAVI

PROFORMA FOR REGISTRATION OF SUBJECT FOR MAIN DISSERTATION

1. NAME OF THE CANDIDATE
AND ADDRESS

2. NAME OF THE INSTITUTE

3. COURSE OF THE STUDY AND .

SUBJECT.

4. DATE OF ADMISSION TO THE

COURSE
5. TITLE

NEED FOR THE STUDY:

REVIEW OF LITERATURE:
Null hypothesis-

Research Hypothesis-

AIM OF THE STUDY:

OBJECTIVES:

MATERIALS AND METHOD:

STUDY DESIGN:
SOURCE OF DATA:

INCLUSION CRITERIA:

EXCLUSION CRITERIA:

PERMISSIONS TO BE TAKEN:

SAMPLE SIZE ESTIMATION:

METHODOLOGY:
SELECTION OF SUBJECTS
INSTRUMENTS AND MATERIALS:

DETAILS OF THE PROCEDURES TO BE CONDUCTED DURING THE

RESEARCH

STATISTICAL TEST :

FUNDING DETAILS :

TOTAL BUDGET

 Material cost
 Equipment cost
 Cost incurring during investigation
 Cost incurring for statistical analysis

Total cost

Name of funding agency

 External Funding
Detail address of the funding agency

 Internal / Self Funding

I Mr/Miss/Mrs__________________________________ agree to take up the financial

responsibility of my research and will bear all the expenses incurred during the study
Signature of the student Signature of the guide
 Does the study require any investigation or intervention to be conducted on patients or
any other human or animals, if so, please describe briefly.

Has ethical clearance been obtained from your institution ?

CONSENT FORM
51

QUESTIONNAIRE

REFERENCES

6. Signature of the candidate

7. Remarks of the guide

8. Name and designation of (in block)

8.1 Guide and HOD

8.2 Signature

8.3 Co- Guide

8.4 Signature
9. 9.1 Remarks of the Chairman and
Principal

9.2 Signature