2017 Science and Innovation Awards for Young People in Agriculture, Fisheries and Forestry

2017 Science and Innovation Awards for

Young People in Agriculture, Fisheries and Forestry

APPLICATION FORM

Applications close at 5.00pm AEDT

Friday 14 October 2016

Applicants should read the material available on the Science Awards website, including the Information for Applicants, frequently asked questions, the assessment criteria and the priorities of the Science Award partners, prior to completing this form.

For further information or enquiries:

Visit:

Email:

Phone: 02 6272 2260 / 6272 2303

APPLICATION CHECKLIST

Please review and complete the following checklist. If you answer “No” to any of the above questions, you are not eligible for the 2017Science and Innovation Awards. If in doubt, contact the Science Awards team.

1. / I have read and understood the material on the Science Awards website including the Information for Applicants regarding eligibility, specific project requirements and lodgement details, and completed all sections of this form. / Yes / No
2. / I am aged between 18 and 35 years (inclusive) by the closing date. / Yes / No
3. / I am an Australian citizen or permanent resident of Australia and have enclosed documentary proof (for permanent residents only). / Yes / No
4. / My project demonstratesinnovation in scientific or technological approach or process and is related to a significant, long standing or emerging issue in agriculture, fisheries or forestry related industry. / Yes / No
5. / My project demonstrates dedication to the future of rural and regional industries with a commitment to promoting science and innovation. / Yes / No
6. / I confirm that my project proposal is not my PhD project. / Yes / No
7. / My project budget is a maximum of $22,000 (incl GST). / Yes / No
8. / My project will commence after the funding agreement is executed and is expected to be completed within 12 months of the execution date. / Yes / No
9. / I confirm that my project has not received funding of any kind from a Commonwealth or State Government department. / Yes / No
10. / I confirm that I am not currently employed by a Non-Corporate Commonwealth Entity. / Yes / No
11. / I confirm that I am not currently employed by an Award sponsor in the category I am applying for. / Yes / No
12. / I confirm that I do not have an immediate family member (eg. a parent or sibling) who is employed by an Award sponsor in the category I am applying for. / Yes / No
13. / I confirm that my host organisation (my employer) is aware of my application. / Yes / No

Double click the grey check box and select “checked” from the menu box

SECTION A - PERSONAL DETAILS - complete all sections
Title
First name
Surname
Date of Birth (dd/mm/yyyy)
Work postal address inc. city / state / postcode
Home postal address inc. city / state / postcode
Phone work
Phone home
Mobile
Email
Your current occupation
Your current employer *
Period with current employer
Employer postal address inc. city / state / postcode
Citizenship (please tick) / I am an Australian citizen
I am a permanent resident of Australia*

Applicants should be aware that if successful, the Department of Agriculture and Water Resources will enter into a funding agreement with the employer, on behalf of the applicant, as the grantee.

* if you ticked this box, please ensure you include appropriate documentation.

SECTION B – INDUSTRY AWARD CATEGORY

Please nominate your Industry Award category (tick one box only). If you wish to apply for more than one category, you will need to submit a separate application.

Award / Award sponsor
Red meat processing / Australian Meat Processor Corporation
Pork / Australian Pork Ltd
Wool / Australian Wool Innovation
Cotton / Cotton Research and Development Corporation
Health and biosecurity / CSIRO Health and Biosecurity
Dairy / Dairy Australia
Fisheries and aquaculture / Fisheries Research and Development Corporation
Grains / Grains Research and Development Corporation
Meat and livestock / Meat & Livestock Australia
Established, new and emerging rural industries / Rural Industries Research and Development Corporation
Viticulture and oenology / Wine Australia
SECTION C – PROJECT PROPOSAL

Describeyour proposed project for this grant. The duration of the grant project is 12 months from signing a funding agreement, so your timeframe should focus on your project activities in this period.Please do not exceed four pages in total excluding the project costing table.

Project title (maximum 20 words)

Overview of the project (maximum 100 words)

Objectives of the project

You may wish to consider these questions in your response(maximum two pages)

Why is this project needed / important? Be clear in your explanation of the industry significance.
How is the project innovative, different or distinct? (eg from current methods being used by industry)
What are the anticipated benefits the project will bring to industry?
What are the anticipated benefits the project will offer you?

Description of the project activities

What activities will be conducted by you as part of the project? (maximum one page)

What are the proposed timeframes and key milestones of the project? (Add more lines if required)

Milestone/activity / Start/end dates*

*Project should not start until a funding agreement is signed, which is likely to be from April 2017. Projects are to be completed within 12 months.

Knowledge sharing (maximum half page)

Outline your plans for sharing your knowledge and experience, including details of the target audience/s relevant to your industry.

Project costing

Provide a detailed costing to a maximum of $22,000 incgst, by listing anticipated costs. You may adjust headings to suit.Ensure that accurate figures are entered as whole dollar amounts, the total project cost is correct and that item costs tally to $22,000 or less.

ITEM DESCRIPTION / TOTAL COST
(incl GST)
Equipment
Training/development/study
Publication
Meetings
Other
TOTAL PROJECT COST inc GST / $
SECTION D – PERSONAL ACHIEVEMENTS

Please provide a brief summary of your achievements related to your work, study (including your PhD status ie planning to study, currently studying, have a PhD or n/a) or rural community involvement (limit two pages).

SECTION E – REFEREE REPORTS

Referees should be currently working, or have recently worked, in a related field and must be familiar with your project proposal.

REFEREE ONE

Referee name
Relationship to applicant

Outcome and benefits – please specify how the applicant’s project would benefit industry

Communication and extension – please comment on the applicant’s ability to communicate the outcomes of this project to industry and other stakeholders, and their likely personal and career benefits

Referee’s position and employer
Daytime phone and mobile
Email
Referee’s signature

REFEREE TWO

Referee name
Relationship to applicant

Outcome and benefits – please specify how the applicant’s project would benefit industry

Referee’s position and employer
Daytime phone and mobile
Email
Referee’s signature

SECTION F – PRIVACY

The collection of personal information by the department in relation to this application form is for the purposes of assessing eligibility of an application for the Science and Innovation Awards for Young People in Agriculture, Fisheries and Forestry programme and related purposes. If the relevant personal information requested in this application is not provided, the department will be unable to assess an application’s eligibility for this programme. Personal information means any information or opinion about an identified, or reasonably identifiable, individual.

Personal information provided to the department is for programme administration and application assessment. In providing personal information, applicants consent to the department using the information for the above mentioned purposes and other related purposes.

Personal information may be disclosed to relevant parties for application assessment and programme evaluation, such as departmental staff, staff of the Award sponsors, judging panel members, the Minister and the Minister’s office, on the department’s website and to other Australia government agencies, persons or organisations where necessary for the above purposes.

Specifically, you may be contacted by the department to discuss and progress your application. If you are successful, your project details, biography and photographs will be used for promotional purposes related to the Awards, including media releases, inclusion on the department’s and sponsors’ websites and through social media including Twitter and Facebook.

You should also be aware that if successful, Commonwealth policy requires the department to publish information on its website about the grant, including, but not limited to:

Name of the recipient of the grant
Purpose of the grant funding
Amount of funding received
Term of the grant and
Location.

Current grant reporting requirements can be viewed at

All disclosure of your personal information will be consistent with relevant laws, in particular the Privacy Act 1988. Personal information will be used and stored in accordance with the Australian Privacy Principles. The department’s Privacy Policy can be found at and includes contact details if you wish to discuss further or to make a complaint.

By submitting this application, I consent to publication of the above information by the department, if I am awarded funding. I hereby consent to such disclosure:

YesNo

SECTION G – DECLARATION

By signing below, I acknowledge that:

-I have read and understood the 2017 Science and Innovation Awards for Young People in Agriculture, Fisheries and Forestry Information for Applicants.

-I have included details of any known or potential conflict of interest below.

-I agree to the publishing of personal information as noted in Section F – privacy.

-The information provided in this application is true and correct[1].

Details of conflict of interest

Dated thisday of2016

Signature of applicant / Signature of witness
Name of applicant (print) / Name of witness (print)

Note: witnesses must be over 18 years old and not related to the applicant.

SECTION H – FEEDBACK (optional)

We would appreciate knowing how you found out about the Science Awards. This section is optional and does not form part of your application or assessment so you may opt to leave it blank.

Newspaper / Name of paper
Social media / Eg ABARES Twitter or Facebook or other
Website / Website address
Award sponsor / Information from Award sponsor (name)
Email newsletter / Details of email newsletter/sender
Other / Please specify
Radio/TV / Name of radio/TV

SECTION I – APPLICATION LODGEMENT

Completed applications are to be emailed and must bereceived by 5.00pm AEDT Friday 14 October 2016

Thank you for your interest and application for the 2017Science and Innovation Awards.

ENDS

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[1] Intentionally giving false or misleading information is an offence under the Criminal Code Act 1995 (Cth).