CSA Class Grant and Contribution Program to Support
Research, Awareness and Learning in Space Science and Technology
Application Form - Research Component
For-profit organization
Industrial Capability-Building Contribution STDP AO3
Notice to Applicants: Please read the CSA Class Grant and Contribution Program Overview in full before completing this application form. You must answer all fields as indicated. Your application will not be considered if there is missing or incomplete information. It is the applicant’s responsibility to ensure that the application complies with all relevant federal, provincial/territorial and municipal laws.
SECTION 1 –APPLICANT INFORMATIONLegal name of the organization:
Operating name (if different):
Address:
Website: / Date of incorporation or registration:
Business Identification Number: / Preferred language for correspondence:
Canadian ownership (percentage): % / Number of employees in Canada:
Full name of contact person: / Full name of authorized representative:
Title: / Title:
Telephone: / Fax: / Telephone: / Fax:
Email: / Email:
SECTION 2 – PROJECT SUMMARY
Project title:
Location of project:
Short summary of the project (300 words) which will be used for public announcements, if the application is successful. The terminology should be understood by a general audience.
Background/Context:
Main objective:
Benefits:
Eligible Technology Themes:
SECTION 3 – BUDGET
Total projectcosts: / Estimated date of start:
Estimated completion date:
Please provide all expenditures and sources of funding for the project.
The total amount and the breakdown by source of funding must be provided for each category of cost.
Budget category / Description and details / Amount requested from the CSA
by Fiscal Year (April 1 to March 31) / Applicant’s
financial contribution / Other sources of funding / Total project budget
FY 1 / FY 2 / FY 3 / FY 4
Salaries and benefits
Consultant services
Material and supplies
Acquisition or rental of equipment (not to exceed 20% of total project cost)
Laboratory analysis services
Data acquisition
Travel
SUB-TOTAL
Overhead (not to exceed 15% of eligible costs)
TOTALCOST OF THE PROJECT:
SECTION 4 – SOURCE OF FUNDING
Please identify any current and proposed funding sources using the information in the detailed budget.
Source of Funding
(Name of funding organization and its funding program) / Contact Person
(Full Name, Title and Telephone number) / Funding Amount
($) / Type of fund (grant, contribution, loan, etc.) / Status(confirmed/ pending) / % of Total Project Budget
CSA: STDP
TOTAL / 100%
Note: in-kind contributions are not considered eligible sources of funding. The funding amount should be expected to be an incurred cost by the applicant.
Applicants that do not complete and meet the following requirements within this application form will be screened out. Applications that are screened out by the evaluation committee will not be evaluated further.
Projects supported under this AO MUST comply with the following definition for basic R&D:
"Any pre-commercial technology activities that are carried out to resolve unknowns regarding the feasibility of space concepts in the space sector."
In order to demonstrate that the project satisfies the above definition please provide the following:
- Quantify the technical objectives being sought and must describe how the expected results will be measured;
- Clearly state which technological unknowns are proposed to be answered;
- Clearly state the working hypotheses behind solving the unknowns and describe how plausible it is anticipated to solve these unknowns;
- Demonstrate that the proposed project consists ofmore than ordinary engineering or current operations; and
- Substantiate the current Technology Readiness Level and proposed Technology ReadinessLevel expected to be reached (upto TRL 6).
Note: Please add pages to this application form, if more space is required to demonstrate that the project is Basic R&D as defined above.
SECTION 6 – SIGNATURE
Application must be post-mailed to the address below:
Industrial Capability Building Contribution STDP AO3Announcement of Opportunity
Sid Saraf
Manager, Technology Development
Canadian Space Agency
6767 Route de l’Aéroport
Saint-Hubert, QC J3Y 8Y9 / I hereby certify that that all information provided in support of this application is, to my knowledge, true and correct.
I declare that I am the Duly Authorized Representative of the organization.
Signature Date
Name:
Applicant Declaration on Confidentiality, Access to Information Act and Privacy Act
The Applicant, by its duly authorized representative signing below, certifies that:
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 to facilitate cooperation between the CSA and the other federal departments and provincial governments in the Applicant's application for such assistance and the review and assessment of the applications, to ensure there will be no duplication of assistance and to confirm that all agreements are being adhered to. The Applicant also authorizes the CSA to gather from other federal departments and provincial governments the information necessary for such purposes.
2.Any authorizations from individuals and other third parties that may be necessary to provide the information required to be submitted in the application 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 for evaluation and selection of proposals. Personal information (such as contact information, biographical information, etc.) included in the rejected proposals will be stored in a Personal Information CSA Bank for 5 years and then destroyed (Personal Information File no. ASC PPU045). Personal information included in the successful proposals will be retained along with the results of their proposals for historical purposes. This data is protected under the Privacy Act. According to the Privacy Act, the data linked to one individual and included in the proposal being evaluated can be accessed by the specific concerned individual 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 the representation made herein are true and accurate.
Signature / DateDuly authorized representative (typed name and title)
Version française disponible / 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
March 2015
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