NSW RESEARCH ATTRACTION AND ACCELERATION PROGRAM

CONFERENCE SPONSORSHIP program

APPLICATION FORM

JANUARY 2016

NSW Research Attraction and Acceleration Program

Application Form

CONFERENCE SPONSORSHIP PROGRAM

The NSW Department of Industry, through the Office of Science & Research, is once again offering grants for research conferences to be held in New South Wales.

This round of the Conference Sponsorship Program is open to individuals and organisations hosting research conferences in metropolitan Sydney, as well as regional and rural New South Wales in 2016.

Grants will be awarded on a competitive basis and are the primary mechanism by which the NSW Office of Science Research provides financial support for research conferences.

For further information about the Conference Sponsorship Program, including eligibility and selection criteria, please refer to the Guidelines for Applicants – Conference Sponsorship Program which can be found at http://www.chiefscientist.nsw.gov.au/investing-in-science/conference-sponsorship-program

This application form must be:

§  completed within the space limit allotted for each response;

§  completed in full and signed by at least one of the conference organisers; and

§  completed electronically

CLOSING DATE

The closing date for applications is 5PM on MONDAY 8 FEBRUARY 2016.

SUBMISSION OF APPLICATIONS

Forms should be submitted electronically to:
Late Applications

Short extensions to the deadlines may be given only in extenuating circumstances and must be received by close of business on FRIDAY 5 FEBRUARY 2016. A request for an extension, explaining the need for and length of the extension, should be submitted in writing to:
Mr Li Chen

NSW Office of Science Research
NSW Department of Industry

A. IDENTIFICATION

A.1. Title of Conference

A.2. Organiser Name

A.3. Category - Please select one of the following categories:

o  Mathematical, information and computing sciences

o  Physical, chemical and earth sciences

o  Engineering, environmental sciences and renewable energy

o  Biological and biotechnological sciences

A.4. Applicant Contact Details

Name
Position
Organisation
ABN
Address
Postal Address
Email
Work Phone
Work Fax
Mobile
B. DETAILS

B.1. Purpose of conference– Describe the aim of the conference and the major focus/topics (maximum 500 words).

B.2. Funding amount requested

B.3. Sponsorship package details – Describe what is included in the sponsorship package being offered i.e. the benefit provided to NSW Department of Industry (such as complimentary registration, opportunity for a departmental banner to be displayed etc.)

B.4. Location of conference/meeting

B.5. Date of conference/meeting

B.6. Estimated number of attendees

NSW
Interstate
International

B.7. Sponsorship Benefits – Describe the benefits the conference will provide e.g. to the research community and the wider significance of the conference (Maximum 300 words)

B.8. Alignment with NSW Premier’s Priorities – Please indicate how the conference aligns with the NSW Premier’s Priorities, and how it will benefit New South Wales

(https://www.nsw.gov.au/making-it-happen)

(Maximum 300 words)

B.9. Other Funding Sources – Please list any other major sponsors and partners

Name / Amount

B.10. Estimated budget of the conference – please list budget allocation in the fields below against each line item

Item / Amount
Venue
·  Room Hire
·  Signage
·  Audio/visual
Catering
·  Canapés
·  Lunch/dinner
·  Alcohol
·  Catering staff
Marketing
·  Logos
·  Website design and registration
·  Advertising
Administration/Stationery
·  Transport concessions
·  Conference materials (pens, paper, water etc.)
·  Name badges
·  Registration
·  Brochures/flyers etc.
Additional Salaries
·  Presenters
·  Additional staff
Accommodation (if required)
Other (please specify)
Total Expenditure
Income
·  Registrations
·  Additional sponsorship
Funding requested from Office of Science and Research

B.11. Additional points not covered to support the application (Maximum 200 words)

C. CERTIFICATION AND DECLARATION

NOTE: Please print this page, sign, scan and email with application.

I provide permission for the NSW Government to release the details of the above conference to a third party:

o  Yes

o  No

.

I certify that:

All details in this application are true and complete, and all named participants in the application have agreed that this application is an accurate representation.

I have identified any information that the applicant requests to be treated as confidential

Conference organiser or representative

Signature ______Date ___/___/___

END