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 materials-research@unimelb.edu.au 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)