Environmental Research Program 2015 – Application Form Page 2

Environmental Research Program

Invited Application Form

Closing Date: 5pm Friday 26 June 2015

To complete this form you must have the latest Adobe Acrobat Reader installed, please visit http://get.adobe.com/reader/ to ensure you have the latest version.

Refer to the Environmental Research Application Guidelines for completing your invited application and the Program Guidelines prior to completing this Form.

If you have any questions, contact (02) 8837 6093 or email info@environmentaltrust.nsw.gov.au

Please answer every question. Where a question does not apply to your proposal, write ‘not applicable’ or preferably briefly explain why. This form is set in size and text boxes will not expand.

Is this project title the same as your EOI project title? Yes No Title First Name Surname Organisation Position Phone Mobile Email Have these details changed since submitting your EOI? Yes No

Before you begin

Section A: Project details

A2 Project title (maximum of 68 characters including spaces)

A1 Insert your reference number

A3 Contact details for Principal Investigator (may not be in lead organisation)

2014 / RD /

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Organisation ABN Registered for GST Yes No Postal Address Suburb State Post Code Have these details changed since submitting your EOI? Yes No Title First Name Surname Position Phone Mobile Email Collaborator 1 Title First Name Surname Position Organisation Collaborator 2 Title First Name Surname Position Organisation

A5 Primary contact in lead organisation (for all correspondence)

A4 Lead organisation details

A6 Key collaborators (i.e. project partners and end-users). You must include at least one end-user. Proof of collaborations listed here must be provided with your invited application. If evidence of collaboration is not

provided, your application will not be assessed.

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Collaborator 3 Title First Name Surname Position Organisation

A8 Time frame. Projects must start between 1 January 2016 and 1 March 2016

A9 Budget. Amount you are seeking from the Environmental Trust

A7 Project description Please describe your environmental research project in 100 words or less. (Please note that this summary will be

used for all promotional material relating to the grant, i.e. media, web site etc.)

Proposed start date

Submit progress report for Stage 1

Submit progress report for Stage 2

Submit final report (covering Stages 1, 2 and 3)

Stage 1 $

Stage 2 $

Stage 3 $

Total amount requested $

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A10 Geographic reach. Either specify particular LGA/s, Local Land Service (LLS) areas and electorates or ‘state-wide’ if your project has a state-wide benefit.

Criterion 1: Significance for the NSW Environment

Section B: Response to assessment criteria

B1 Please explain your reasons for developing this project and how anticipated outcomes will advance the knowledge base (include comment on knowledge/information gaps that the project seeks to fill)

B2 Summarise the literature and consultation used to justify the relevance of your project, and develop your proposal

You should draw on your response to question B10/B11 in the Expression of Interest.

B3 What is innovative or original about your project?

LLS region

Main local government area(s)

State electorate(s)

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Criterion 1: Significance for the NSW environment and criterion 2: approach and methodology

B4 Project planning

OBJECTIVE 1

Outcomes (What will success look like if you achieve this objective?)

Research methodology/experimental design overview

Activity (Significant steps or actions

that are needed to produce the identified objective)

Stage(s) undertaken? (i.e. Stage 1, 2 or 3 [may

occur over multiple years] of the project)

Team member(s) or collaborator responsible How will this activity be evaluated?

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Criterion 1: Significance for the NSW environment and criterion 2: approach and methodology

B4 Project planning

OBJECTIVE 2

Outcomes (What will success look like if you achieve this objective?)

Research methodology/experimental design overview

Activity (Significant steps or actions

that are needed to produce the identified objective)

Stage(s) undertaken? (i.e. Stage 1, 2 or 3 [may

occur over multiple years] of the project)

Team member(s) or collaborator responsible How will this activity be evaluated?

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Criterion 1: Significance for the NSW environment and criterion 2: approach and methodology

B4 Project planning

OBJECTIVE 3

Outcomes (What will success look like if you achieve this objective?)

Research methodology/experimental design overview

Activity (Significant steps or actions

that are needed to produce the identified objective)

Stage(s) undertaken? (i.e. Stage 1, 2 or 3 [may

occur over multiple years] of the project)

Team member(s) or collaborator responsible How will this activity be evaluated?

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Criterion 3: Communication and dissemination

Risk How risk will be managed

B6 Who will benefit from this new knowledge? (Include reference to end-users, for example, which decisions and decision-makers this research will inform.)

B5 What are some of the potential risks that could hinder progress of the project and how will you manage them?

Rating

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B7 Communications strategy Please use the table below to outline how you will involve collaborators, particularly end-users. Your strategy should detail how you will engage collaborators/end-users during the life

of the project, as well as to promote, implement and disseminate research findings.

Target audience (collaborator or end-user)

Target message (audience interest) Communication method Evaluation method

to determine effectiveness Who is

responsible?

Stage(s) activity will be undertaken?

(i.e. Stage 1, 2 and/or 3 of the project or post-project)

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B8 Will any part of the research be ‘commercial-in-confidence’?

B9 Commercial output

Criterion 4: Lead applicant and collaborators

B10 Outline your research team (include project leader, project employees and consultants/sub-contractors).

Individual and organisation Job/function Paid by whom?

CV provided?

B11 Explain why this research team are best placed to deliver this research

Will the results or product of the research be sold or licensed?

Unit cost $ Retail price $

Estimated number of sales/licences

Estimated profit (if any) from sales/licensing $

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B14 Collaborators Provide further detail on the contribution on collaborators listed at question A6 here (i.e. your project partners and

end-users), and list any additional collaborators .

B13 What selection criteria will you use to employ project staff and who will be making the selections?

Individual and organisation Outline skills, capacity and/or

expertise they are bringing to the project

B12 Outline your communications team i.e. the expertise required to deliver your communications strategy.

Individual and organisation Job/function Paid by whom?

CV provided?

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It is a condition of your grant that you have adequate insurance cover including public liability insurance of $10 million, workers compensation and volunteer insurance.  Company: Policy No/s: Coverage: Currency (expiry date):

Further information

B15 If applicable, please list any specific issues from the EOI process that you were asked to address in your application and detail how you have addressed them. You may also respond to peer review comments here.

B16 Please declare any real, potential or perceived conflict of interest you may be aware of and how you intend to manage the conflict.

B17 Please provide details of your insurance(s)

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Name

Title/position

Organisation

Email

Phone No.

Mobile No.

Date

Name

Title/position

Organisation

Email

Phone No.

Mobile No.

Date

Section D: Authorisations

Section C: Referees

Organisation

Applicant authorisation 1 Applicant authorisation 2

Organisation

Name Name

Position Position

Date Date

Referee 1

Referee 2

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Please provide some basic feedback on your experience with applying to the Research program. All feedback will be collated to provide overall picture and used to assist development of future Environmental Trust documentation.

Less than 5 hours 5 – 20 hours 2 - 40 hours More than 40 hours

Less than 2 hours 2 - 5 hours 5 - 10 hours More than 10 hours

Very easy Easy Moderate Difficult Very difficult

The following attachments are required as part of your invited application:

Published by the NSW Environmental Trust, PO Box 644, Parramatta 2124 Phone: 02 8837 6093 Fax: 02 9895 6548 Email: info@environmentaltrust.nsw.gov.au Website: www.environmentaltrust.nsw.gov.au OEH 2015/0043 February 2015

Attachments

Application Evaluation

1. Time taken to develop your project (including negotiation with collaborators)

2. Time taken to complete the application form

3. Difficulty completing the application

Written confirmation of commitment from key collaborators, including end-user(s)

Curriculum Vitae for key researchers involved in the project (2 pages maximum)