Application Form s19

CSA Class Grant and Contribution Program to Support Research, Awareness and Learning in Space Science and Technology

Application Form Canadian CubeSat Project (CCP)

Notice to Applicants: Please read the Canadian Space Agency (CSA) Class Grant and Contribution Program Overview in full before completing this application form. These documents are available on the CSA Web site under Grants and Contribution tab. Enter answers in all fields as indicated. Your application may not be considered if it is incomplete. It is the applicant’s responsibility to ensure that the application complies with all relevant federal, provincial and territorial legislation and municipal bylaws. Please do not change the format.

SECTION 1 – APPLICANT INFORMATION Legal name of the organization (must be confirmed by the Office of Research)

Full name of Principal Investigator (PI)

Title/Position

Address

Telephone Fax

Preferred language for correspondence ☐ Français ☐ English SECTION 2 – PROJECT BUDGET SUMMARY Proposal title:

Amount requested from the CSA per Total Project Budget installment (CSA + Other) Installment 1 Installment 2

The information collected on this form and appendices will be stored in the Personnel Information Bank of the CSA Grant & Contribution Program to Support Research, Awareness and Learning in Space Science and Technology. PROTECTED WHEN COMPLETED Version française disponible

SECTION 3 – SIGNATURES Principal Investigator I declare that I am the Principal Investigator for this project.

Signature Date

Duly Authorized Signatory Full name of duly authorized signatory

Applicants must mail one (1) Telephone Fax paper copy of the proposal (with original signatures) and an identical electronic copy of the Email proposal saved in a standard media format (USB key, CD or DVD) to: I declare that I am the duly authorized signatory for the organization. Signature Date Canadian CubeSat Project AO c/o France Bolduc Space Science and Technology Canadian Space Agency 6767 Route de l’Aéroport,

Saint-Hubert, QC, J3Y 8Y9

SECTION 4 –ELIGIBILITY CRITERIA The following criteria will be used by the CSA to pre-screen the applications. Each criterion MUST have at least one box checked off and/or the required information provided. Applications that fail to meet one or more criteria will be deemed non-compliant and will not be assessed further. Please check all applicable boxes and/or provide all requested information. Name of the Mission Mission Type (see AO ☐ T-Class ☐ S-Class ☐ C-Class Appendix A, Section A6) ☐ E-Class Institution of PI ☐ University ☐ College Province / Territory of PI If applicable, list of top 5 1. Click here to enter text. Canadian collaborators (name of institution and 2. Click here to enter text. province/territory) 3. Click here to enter text. 4. Click here to enter text. 5. Click here to enter text.

If applicable, list of top 5 1. Click here to enter text. international collaborators (name of institution and 2. Click here to enter text. country) 3. Click here to enter text. 4. Click here to enter text. If none, click the box below 5. Click here to enter text. ☐ No international

collaborator Planned total number of PDF 0 Graduates 0 Undergraduate 0

HQP to be involved in the College 0 project Planned number of High school 0 Students to be involved in the project CubeSat format(s) ☐ 1U ☐ 2U ☐ 3U proposed (maximum 2) Expected completion ☐ 24 months ☐ 36 months For CSA use only: ☐ Compliant ☐ Non-compliant Result of pre-screening

SECTION 5 – PROJECT SUMMARY Please provide a short summary (maximum of 100 words) of the proposal using non-technical language for public release in case your proposal is accepted.

Please describe the project using keywords (maximum of 10) separated by semi-colons.

Please indicate if you have access to Electronics Workshop and to an Assembly Facility. ☐ Available in PI or co-PI institution and a brief description below Click here to enter text.

☐ Not available in PI or co-PI institution and will procure ☐ Not available in PI or co-PI institution and will not procure Ground Station ☐ Available in PI or co-PI institution Click here to enter text.

☐ Not available in PI or co-PI institution and will build

☐ Not available in PI or co-PI institution and will not build

SECTION 6 – TEAM MEMBERS (PRINCIPAL INVESTIGATOR, CO- INVESTIGATORS) IMPORTANT: please attach curriculum vitae (CV) or the CSA CV Form (CV Form Sept 2017) for the Principal Investigator and for each of the Co-Investigators.

In the following, please provide the names and contact information of the team members (including the PI and all Co-PIs). Attach additional sheets if needed. Team Member 1 Full Name Email

Title / Position Telephone Number of HQP and students to be supervised: Organization Role in the project

Team Member 2 Full Name Email

Title/Position Telephone Number of HQP and students to be supervised: Organization Role in the project

SECTION 7 - DETAILED BUDGET AND SOURCES OF FUNDING

Please provide a detailed, itemized budget indicating all sources of funding for the project and project expenditures. - Information should be broken down per government fiscal year (April 1st to March 31st); - All funding sources and all expenditures must be included, and identified as cash or in-kind; - For each expenditure, the source of funding (or in-kind contribution), the total amount(s), and the breakdown by source of funding must be provided.

Please refer to Section 7.2 of the CCP AO for a list of eligible costs.

Budget Breakdown (C$) Amount Requested from the CSA Total Total Amount Project Budget Description Year 1 Year 2 Requested Budget Category and Details TOTAL from Other (April 1 to (April 1 to (2-year) (CSA + March 31) March 31) Sources Other) Licence and permit fees (including but not limited to software licences) Access fees to laboratories or special facilities Registration fees (for events in direct support of a public engagement plan) Data acquisition

Acquisition or rental of equipment (not to exceed 20% of the grant for laboratory instruments or equipment)

SECTION 8 – DETAILED BUDGET AND SOURCES OF FUNDING Using the information in the detailed budget, please identify any current and/or proposed funding sources. Source of Funding Contact Person Type of Funding % of Total Confirmed (Name of Funding (Full Name, Title and Funding (In- Amount Project Funding? Organization and its Funding Telephone Number) kind, (C$) Budget (YES / NO) Program) Grants, etc.)

SECTION 9 – OTHER

If applicable provide as letters of support from each co-investigator listed and letters of intent from organizations providing other sources of funding or in-kind contributions. Click here to enter text.

CSA Class Grant and Contribution Program to Support Research, Awareness and Learning in Space Science and Technology Application Form – CCP AO

Applicant Declaration on Confidentiality, Access to Information Act and Privacy Act The Applicant, through its duly authorized representative signing below, certifies as follows:

1. The Applicant authorizes the Canadian Space Agency (CSA) to share this application (including supporting material) with other federal and provincial government sources of assistance in order to facilitate cooperation between the CSA and other federal departments and provincial governments for the purposes of the Applicant's application for such assistance, as well as to review and assess applications to ensure that there is no duplication of assistance and to confirm compliance with all agreements. The Applicant also authorizes the CSA to gather from other federal departments and provincial governments the necessary information for such purposes.

2. Any relevant authorizations from individuals and other third parties have been obtained.

3. Necessary measures have been taken to protect the confidentiality of the information provided by the Applicant. This information is collected under the authority of the CSA Class Grant and Contribution Program to support Research, Awareness and Learning in Space Science and Technology – Research Component and will be used to assess and select proposals. Personal information (such as contact information, biographical information, etc.) included in rejected proposals will be stored in a CSA Personal Information Bank for five years and then destroyed (Personal Information File no ASC PPU045). Personal information included in successful proposals will be kept along with the results of their proposals for historical purposes. These data are protected under the Privacy Act. The Privacy Act states that the data associated with an individual and included in the assessed proposal can be accessed by the particular individual concerned, who has rights with respect to this information. This individual may, upon request, (1) be given access to his/her data, and (2) have incorrect information corrected or have a notation attached.

4. The Applicant understands that the information provided in this application (including supporting material) is subject to the federal Access to Information Act and Privacy Act. I certify that I have read and clearly understand the above information and that the representation made herein is true and accurate.

Signature Date

Duly Authorized Representative (typed name and title)

Supporting Documentation Form (for Organizations in Quebec) Relative to Chapter M-30 of the

Act respecting the ministère du Conseil exécutif , R.S.Q., c. M-30.

Please review the relevant provisions of the Act, complete this form, have it signed by the Duly Authorized Representative, and return it to the CSA along with all the required supporting documents in your application.

Project Title

Legal Name of Entity/Organization

1) Under section 3.11, is the Applicant (proposed payee) a municipal body Yes No or school body within the meaning of section 3.6.2 of the Act?

2) Under section 3.12, is the Applicant (proposed payee) a public agency as Yes No defined by section 3.6.2 of the Act?

3) If there is a signed agreement between the Applicant and the CSA, will the agreement affect a government agency, municipal body, school body Yes No or public agency within the meaning of the Act?

If you answered “Yes” to any of the above questions, you must:

 Obtain the authorization from the Secrétariat aux affaires intergouvernementales canadiennes of the Quebec government before signing the funding agreement; and  Provide a copy of this authorization along with your application.

If you answered “No” to all three questions, please submit this form, signed by the Duly Authorized Signatory, with your application and any appropriate supporting documents.

I certify that I have read and clearly understand the above information and that the representation made herein is true and accurate.

Signature Date

Duly Authorized Representative (typed name and title)