HALLMARK MATERIALS RESEARCH INITIATIVE

INDUSTRY SEED FUNDING SCHEME 2016-2017

APPLICATION FORM

This application form consists of four elements:

A)  Checklist.

B)  Project Proposal. Maximum 3 pages.

C)  Supporting Documentation. Each Team Member (Lead Chief Investigator and Partner Investigator) must provide a statement of no more than one page in total with the following information: (1) current position; (2) expertise relevant to the proposed role in the current proposal, including track record and (3) a representative list of grants and/or publications in areas relevant to the proposal.

D)  Proof of Partner Organization Fund Commitment. The Lead Chief Investigator must obtain and submit the proof of Partner Organization Fund Commitment in the same time as the application.

All the elements in this application must be completed.

Applications with sections missing may be regarded as non-eligible by the Selection Committee.

The application must be submitted as a single PDF file.

Applications should be submitted via email to using this format:

-  Email subject: ISF-Application-Year-CI’s Initial + LastName. (example: ISF-Application-2015-JSmith)

-  Application in a single file (PDF format) with the file name: ISF-Application-Year-CI’s Initial + LastName. (example: ISF-Application-2015-JSmith)

Applicants are strongly advised to read the Funding Rules and Guidelines for details about the scheme, conditions of grant, staff eligibility and selection process. Click here to see the Funding Rules and Guidelines.

A)  CHECKLIST

Lead Chief Investigator Information

Name
Department
School/Faculty
email

Partner Organization Information

Name
Address
State
Contact person

Partner Investigators Information

Name / Department / Faculty/School/Institution / email

Is there an existing collaboration between any of the Team Members and the External Partner/Industry/Hospital/Collaborating Institution?

X / Yes / If yes, please provide details
X / No

Have any of the team members previously worked together?

X / Yes / If yes, please provide details
X / No

Has this proposal been submitted to any other Funding Body?

Yes / If yes, please provide details
No

Is this proposal part or continuation of an existent research project or consultancy project?

Yes / If yes, please provide details
No

Will this proposal be used to provide a consultant/contract service?

Yes / If yes, please provide details
No

Has the Team discussed the potential Intellectual Property that may be developed under this project ?

X / Yes / If yes, please provide details
X / No

Which focus area does this proposal most suitably align with?

Materials for Medicine
Materials for Energy
Controlled Assembly of Materials

I understand and accept the conditions and terms of this grant by signing this document:

Signature of the Lead Chief Investigator on behalf of the Team:
Print name / Date
Signature of the Head of the Department
Print name / Date

B)  PROJECT PROPOSAL- Maximum 3 pages.

Project Title (Maximum 10 words)

Project Summary (Maximum 250 words)

Project Description

Amount requested from Hallmark Materials Research Initiative

Budget breakdown

Category / Details / Amount (AUD)
Staff
Consumables
Equipment
Travel
Partner Organization Cash Contribution
Partner Organization in-kind contribution (if applicable)
Total

Budget justification

Relevance to the Hallmark Materials Research Initiative

Roles of the Team Members

Engagement with Partner Organization

Expected outcomes

How this project proposal will lead to future funding

C)  SUPPORTING DOCUMENTATION

Each Team Member must provide a statement of no more than one page in total with the following information: (1) current position; (2) expertise relevant to the proposed role in the current proposal, including track record and (3) a representative list of grants and/or publications in areas relevant to the proposal.

Team Member Name:
Current Position:
Expertise relevant to the proposed role in the current proposal:
Representative lists of grants/publication in areas relevant to the proposal collaboration:
Team Member Name:
Current Position:
Expertise relevant to the proposed role in the current proposal:
Representative lists of grants/publication in areas relevant to the proposal:
Team Member Name:
Current Position:
Expertise relevant to the proposed role in the current proposal:
Representative lists of grants/publication in areas relevant to the proposal:
Team Member Name:
Current Position:
Expertise relevant to the proposed role in the current proposal:
Representative lists of grants/publication in areas relevant to the proposal:
Team Member Name:
Current Position:
Expertise relevant to the proposed role in the current proposal:
Representative lists of grants/publication in areas relevant to the proposal:
Team Member Name:
Current Position:
Expertise relevant to the proposed role in the current proposal:
Representative lists of grants/publication in areas relevant to the proposal:

D)  PROOF OF PARTNER ORGANIZATION FUNDS COMMITMENT.

Name of Partner Organization:
Address:
State:
Postcode:
Country:
Contact person (name, email and phone number):
Intended Cash Amount to commit to this project:
ABN:
If funded by the Hallmark Materials Research Initiative Industry Seed Funding Scheme, it is our intent to sign an agreement with this Team at this cash level.
Authorizing signature
Print name / Date
Stamp

(If applicable please attached scanned copies of relevant documentation)