AUSTRALIAN INSTITUTE FOR THE CONSERVATION OF CULTURAL MATERIAL INC.

GPO Box 1638 CANBERRA ACT 2601

2014Application Form

AICCM Queensland Inc PROFESSIONAL DEVELOPMENT GRANTS UP TO $450

CLOSING DATES AND NOTIFICATION
Closing date for AICCM Q Professional Development Grant application is1 July 2014. Applications will be accepted for events occurring more than 5 weeks, but less than 12 months from the application date.
Applicants are advised of the outcome within four weeks of the application date
SELECTION PROCESS
The applications will be reviewed and a final decision made by the AICCM Q Professional Development Committee. Applications are assessed againstcriteria including: appropriateness of the event to furthering the applicant’s professional development; qualifications of the applicant; the applicant’s demonstrated involvement in AICCM Q and their ability to publish/lecture on the event to the benefit of members; previous funding received by the applicant from AICCM Q Professional Development Fund; limited other financial assistance available for the program (including workplace funding); completeness of application and compliance with eligibility criteria below.
ELIGIBILITY
  • Professional development grants support activities and opportunities that will significantly develop and advance your professional knowledge and skills
  • Applicants must be Queensland residents
  • Applicants must be individual AICCM Q members of 5 years standing
  • Applicants must provide a follow up lecture/workshop to AICCM Q members and a written review/article for the AICCM National Newsletter within the financial year
  • Funding can support attendance at AICCM and non-AICCM organised events
  • Applicants are reminded that they should not make any financial commitment in the expectation that they will receive funding.
  • Should the professional development activity be cancelled or delayed, or the funded participant is unable to attend, all money must be returned to the AICCM Q.
  • A final report is to be submitted to AICCM Q within 30 days of the event completion. Final Report Forms are available from AICCM Q Secretary.

OFFICE USE ONLY
Application no:______
Applicantname:______

1. ABOUT THE APPLICANT

1.1Applicant details
Title: / Mr / Ms / Other (please specify):
Given names:
Family name:
Job title and employer
 / Go to 1.2

1.2 Contactdetails

Street address:
Suburb/town: / State: / Postcode:
Postal address:
(If the same as your street address, write ‘as above’.)
Suburb/town: / State: / Postcode:
Telephone: Work / () / Home: / () / Fax: / ()
Mobile: / Email:
Website address:
Have you applied for an AICCM Queensland PD grant before? / Yes / No
If yes, under which name?
 / Go to 1.3
1.3 AICCM Membership details
AICCM membership number
Queensland member since / DD/MM/YYYY
Ordinary Member / Professional member
 / Go to 2.1
2 PROFESSSIONAL DEVELOPMENT PROPOSAL
2.1 Proposal summary
GRANT FUNDING REQUEST: (Use whole dollars only) / $
Your application will NOT BE ELIGIBLE if your proposal begins less than five weeks from the application date / START DATE for proposal / DD/MM/YYYY
FINISH DATE for proposal / DD/MM/YYYY
Proposal title:
Please outline your proposal (please do not refer to attachments) (MAX1400 words)
Please include:
  • what you plan to do
  • where and when will it take place (including a programme if available)
  • why this is a good/unique opportunity for you
  • the significance of this proposal for your career
  • how you will use the AICCMQ PDgrant money

The funding will be used towards
Where will your proposal happen?
Please include institution (if relevant), town, city or country if overseas (e.g. Bundaberg, Perth)
 / Go to 2.2
2.2 Outcomes/ Benefits to Conservation profession/community in Queensland. Please describe how you plan to feedback to AICCM Q members.
(Note: An Outcome Report, including financials, 1-2 pages in length will also be required 30 days after event to acquit the grant.)
Presentation
Publication
Other
 / Go to 2.3
2.3 Budget Information
Please list costs needed to complete the grant proposal. Include any expenses in addition to those for which you are applying. Note AICCM Q PDG funding is not eligible for meals and incidentals, thus this line is not included below.
Item / Description and Calculations / Additional funds amount / Total estimated costs / Source of funds
(e.g. AICCM Q PDG, Self, Institution, other funding)
Registration / $: / $:
Transportation / $: / $:
Accommodation / $: / $:
Other (please describe) / $: / $:
Total Proposal Expenses / $: / $:
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2.4Other financial assistance

Please indicate other financial support you have applied, or intend to apply for,to undertake your proposal. If you have already been notified of your successful grant, please include the amount you received. If further notification of funding from other areas is received after your submission to AICCM (Qld) Inc, please notify us as soon as possible. The level of other assistance available will be a consideration in assessing applications and any conditions will be detailed in a Funding Agreement to be signed by the successful applicant.
Funding body/agency / Funding program / Phone no. / Date applied / Date notified / Amount requested
DD/MM/YYYY / DD/MM/YYYY / $:
DD/MM/YYYY / DD/MM/YYYY / $:
 / Go to 3.0
3. SUPPORT MATERIAL
The following support material is recommended.
A CV no longer than two A4 pages
Written confirmation of relevant activities (e.g. registration details, letters of acceptance)
Itinerary of tour or travel arrangements (if applicable)
Conference/workshop program (if applicable)
Please note
  • For audit purposes, AICCM is required to retain all support material supplied by applicants.

 / Go to 4.0
4. CERTIFICATION

All applicants

I, the undersigned, certify that:
  • The statements in this application are true and correct to the best of my knowledge, information and belief, and the supporting material is my own work.

  • If this application is approved, I consent to the media being given information about the funded proposal.

Signature: /  / Date: / DD/MM/2013
Name in full:
 / Go to 5.0
5. APPLICATION PREPARATION

BEFORE YOU SEND IN YOUR APPLICATION MAKE SURE

You have answered all the questions on the application form.
You have checked that your proposal’s starting date falls more than 5 weeks, but less than one year after the submission date.
You have signed the application form
You meet the eligibility criteria specified on the front page and you are submitting theapplication form, cv, confirmation of activity, itinerary, conference program (if relevant).
You have kept a copy of your application for your own records.
PLEASE SUBMIT YOUR APPLICATIONINCLUDING SUPPORT MATERIAL ELECTRONICALLY TO

If you require further information or assistance

AICCMQ Professional Development Grants 2013-4