Application Form for Funding in 2018

UWA Research Impact Grants

Application form for funding in 2018

Closing date 5pm 13 October 2017

Prior to completing this application please refer to the Guidelines: http://www.research.uwa.edu.au/staff/rgco/find-funding/internal-schemes#is-5-4

APPLICATION INFORMATION

First Named Chief Investigator

Title: Given Name: Surname:

Staff No. School/Centre:

Email:

FTE (for period of award): % Adjunct ☐ Honorary ☐ Emeritus ☐

Personnel and Related Details Additional Chief Investigators  Please refer to the guidelines for eligibility. Full Name (Title Given CI# Employee No. School/Centre/Institution Name Surname) (if applicable) 2 3 4 5 6 7 8 9 10

Are you applying for an:

Academic - Research Impact Grant ☐ Academic impact on a discipline through high quality publications and presentations at international conferences Impact Beyond Academia - Research Impact Grant Impact beyond academia through supporting interactions with non-academic users and beneficiaries of ☐ research through events such as industry showcases, public awareness campaigns, and stakeholder and community engagement activities. Project Details

Project Title

Project Summary Provide a plain language summary of you proposal, approx. 100 words. This may be used for promotional purposes

Requested Budget

Total funds requested: $ (maximum $20,000)

Research Classifications The definitions for each type are found at: http://www.research.uwa.edu.au/staff/rgco/apply-for-funding#apply-3

Fields of Socio-Economic Type of Research Activity % FOR % SEO Research (FOR) Objective (SEO) Strategic Basic Research ☐ Experimental Development ☐ Pure Basic Research ☐ Applied Research ☐ 100% 100% Please enter 6-digit FOR and SEO codes. The codes must not end on ‘00’. Selection Criteria (Combined 1 page maximum. Headers must remain but instructional text can be deleted) 1. Underpinning Research Provide details of the research that underpins the proposed activities.

2. Beneficiaries and Impact of your research List the potential beneficiaries of your research and the potential impact upon them. This may include: academic community; industry; government; professional association; and broader community. Include specific groups where possible.

3. Dissemination and knowledge transfer activities Outline the dissemination and knowledge transfer/translation activities that you will undertake as part of the grant. Budget - 1 page maximum The funding may be used to support activities which include presenting at a conference, socialising research via various networks, publication costs, teaching relief to write a research journal article or other research publication with likely high impact, workshop and event costs, and media and public awareness activities. Refer to the RIG Guidelines and Conditions for non-allowable budget items. All amounts should be listed GST exclusive

Item and brief description $

Total Cost of project

Budget Justification Please provide a brief justification for your budget items linking them to your proposed activities (max 200 words)Certification

 All Chief Investigators have agreed to take part in the proposed collaboration.  All details on this application forma are true and complete.  The project is viable in terms of the School's resources and the funds requested. All budget items have been appropriately costed e.g. travel, accommodation.  The project can be accommodated within the facilities of the School and sufficient working and office space is available for any proposed visiting personnel.  The project will not be permitted to proceed until appropriate ethics clearance(s) has been obtained.  There are no outstanding final reports from previous funding received under this scheme.  Having read and understood any conditions attached to this application I am satisfied with and willing to observe them. Head of School First-named Chief Investigator (Principal contact on behalf of all Investigators) If Head of School is a Chief Investigator, the Dean must sign

Name Name

Signature Date Signature Date