Introduction
ThisApplicationshouldbecompletedifyouwishtoapplyforfundingfromtheInnovationConnectGrantProgram,AcceleratingInnovationfundingcategory.ItisstronglyrecommendedyoucontactanInnovationConnectClientManager beforeattemptingtocompleteandsubmitthisform.
SupplementaryinformationregardingtheIConGrantProgramiscontainedat
Phone:0262077215orthrough132281
Email:
Eligibility
*indicatesarequiredfield.
Submission Policy and Process
Applicationsmaybesubmittedatanytime.
EligibleapplicantswillbeaskedtopitchtoInnovationConnectdecisionmakers.
Checklist
Beforecompletingthisapplicationform,ensureyouhavereadtheAcceleratingInnovation-InnovationConnectProgramGuidelinesandFAQ'savailableat
Thefollowingsectionmustbecompletedbytheapplicant:
Doesyourorganisationhaveanannualturnoveroflessthan$2million? *
YesNoResponserequired.
IsyourorganisationbasedintheACTregionandcanyoudemonstratethatyourfutureactivitieswilleconomicallybenefittheregion?*
YesNoResponserequired.
You will be asked to justify how your project will benefit the ACT later in this form.
Doyouhave,orhaveyouappliedforanABN?*
YesNoResponserequired.
You must have an ABN before you enter into an agreement for funding assistance through Innovation Connect
AreyoupreparedtoenterintoaformalagreementwiththeACTGovernmentthatreflectstheamountandtermsofthefinancialassistanceoffered*
YesNoResponserequired.
A draft funding Deed of Agreement can be found at
Canyouputintoyourprojectaleveloffunding,(includingin-kind)thatmatchestheamountoffundingyouarerequestingfromInnovationConnect?*
YesNoResponserequired.
See Page 6 of this application and
Iftheanswertoanyofthechecklistquestionsaboveis"no"pleasecontactanInnovationConnectclientmanager.
Phone:0262077215orthrough132281Email:
YouandYourBusiness
*indicatesarequiredfield.
Applicant Organisation Details
UploadanyattachmentsrequestedorotherwiseelevanttothissectionusingtheFileUploadquestionattheendofthis"YouandyourBusiness"section
ApplicantOrganisationName*
Primary(Physical)Address*
Address
SuburbStatePostcode
Must be an Australian post code
PostalAddress(ifdifferentfromabove)
Address
SuburbStatePostcode
Must be an Australian post code
Brieflydescribeyourbusinessanditshistory.
Include thnigs like history, goals, structure of your business
ApplicantWebsite
Must be a URL
ContactPerson*
TitleFirstNameLastName
PositionheldinOrganisation*
PrimaryPhoneNumber*
Must be an Australian phone number
ContactMobilePhoneNumber
Must be an Australian phone number
ApplicantAdminContactPrimaryEmail*
Must be an email address
ABN*
TheABNprovidedwillbeusedtolookupthefollowinginformation.ClickLookupabovetocheckthatyouhaveenteredtheABNcorrectly.
Add date of ABN application if you are in the process of getting one
Whatwasyourbusinessesturnoverlastfinancialyear?
No disadvantage if you are a startup and this is zero
Howmanyemployeesdoesyourbusinesscurrentlyhave?
Full Time Equivalent
Whatisyourcapacitytosuccessfullyundertaketheproject?
Wordcount:
In less than 500 words detail you and your business's experience and access to expertise and resources required to deliver the project you will describe at page 4.
Whoareyourprojectteam?
Wordcount:
In 500 words or less list your project team and the skills they bring to the project. Provide CV's where relevant through the "upload" question below
File Upload
Uploadallattachmentsrelatedtothis"YouandYourBusiness"sectionhereAttachafile:
YourProductandIt'sMarketPotential
*indicatesarequiredfield.
Product Description
UploadanyattachmentsrequestedorotherwiseelevanttothissectionusingtheFileUploadquestionattheendofthis"ProductDescription"section
Whatisyourproduct(orservice)called? *
BrieflyDescribeYourProduct*
A snappy sentence describing the essence of your product for use in media releases for example
Whatproblemdoesyourproductaddress?*
Wordcount:
In no more than 500 words describe the need for your product
Whatsolutiondoesyourproductdeliver?
Wordcount:
In no more than 500 words describe how your product is a good solution to the problem described in the above question
Whatistheinnovationinyourproduct?Howdoesyoursolutionopenupnewmarketsbybeingdifferentfromexistingsolutions?*
Wordcount:
In no more than 500 words decribe the "new to the world" innovation in your product
Howdoyouenvisagefurtherdevelopmentandcommercialisationofyourproductonceproofofconcepthasbeenestablished?*
Wordcount:
In no more than 500 words outline your business model including your route to market, continued development, distribution models, ownership structure etc
Whatisyourrevenuemodel?
Wordcount:
In no more than 500 words outline how you will charge for your product or otherwise monetise your idea. Numbers are requested in section 5 below.
Ifnotintendingtobuildandgrowyourowncompanyinthelongterm-doyouhaveanexitstrategy?
Wordcount:
In no more than 500 words describe the options available to you should you wish to capitalize your business including who may be interested in purchasing it..
Cananythirdpartiesvalidatetheneedforyourproductinthemarketplace?Summariseherethepeopleororganisationswhohavetoldyouitsagoodideaandattachevidence(iesupportletters)wherepossible.
Wordcount:
In no more than 500 words describe any organisations that can validate the need for your product. This may include awards your product has received, metor or expert comments or letters of support. Upload attachments at the bottom of this page if necessary.
Intellectual Property
WhatisyourIPStrategy?
Wordcount:
Up to 500 words describing the IP in your product, who owns it now and how you intend to secure it into the future
Market Potential
Whowilluseyourproductandwhy?
Wordcount:
In no more than 500 words describe who you are targetting to buy your product
Whatisthesizeandpotentialofyourmarket?
Wordcount:
500 words summarising any market research you have undertaken justifying the figures in sections four and five below. Upload any relevant market analysis documents you have at the end of this page.
Whoareyourdirectcompetitors?Whoareyourindirectcompetitors?
Wordcount:
No more than 500 words describing the existing and likely future market competitiors.
Domestic and International Market Potential
AustralianMarketInternationalMarket
EstimatedtotalsizeofEstimatedtotalsizeof
PotentialforyourPotentialforyour
Australianmarkettheinternationalmarket
product/serviceproduct/service
$ / $ / $Must be a dollar amount / Must be a dollar amount / Must be a dollar amount / Must be a dollar amount
Total: / Total: / Total: / Total:
Sales and Income Projections
Showbasisofcalculationseitherbrieflyintherelevant"Item"fieldorinmoredetailinanattachment.
PricingYear1$Year2$Year3$
Budgeted Annual Costs / $ / $$
Economic Benefit for the ACT
Howwillyourproduct'scommercialisationbenefittheeconomicdevelopmentoftheTerritory?
Wordcount:
Up to 500 words. Note that you are asked to address economic development, which includes economic growth but also includes alignment to other government policies such as encouraging diversification of the economy, innovation and trade and investment.
EmploymentFullTimePartTime
File Upload
Uploadanyfilesrelatedtothis"YourProductandItsMarketPotential"sectionhereAttachafile:
You can also "drag and drop" attachments to upload
YourInnovationConnectProject
*indicatesarequiredfield.
Project Summary
ProjectTitle*
Up to 50 words. Title will be used in media releases and other project documentation.
Briefprojectdescription*
Wordcount:
Up to 150 words on what it is you will do to prove the concept of your product. Details can be placed in "Planned Activities" below
ProjectStartDate*
Must be a date
ProjectEndDate*
Must be a date
Project Activities
Whatwilltheprojectproduce?
Wordcount:
In no more than 500 words explain how the completion of your project as described in the activities above will largely prove your product's concept.
Whataretheplannedactivities?*
Wordcount:
In up to 500 words describe the activities to take place under this project and who will perform them. What will the grant funding specifically be used for and allow you to do?
Project Financial Summary
TotalProjectCost*
What is the total budgeted cost (dollars) of your project including your own In-kind and cash-to-third-party contributions?
TotalAmountRequested*$
What is the amount of funding you are requesting of the Innovation Connect program? (Must be between $5,000 and $10,000 and not more than half of the total project cost)
Estimatehowmuchto$
datehasbeenspentonInclude Cash expenditure, (ie on externally purchased goods and services) and In-Kind expenditure (or the value of
yourproductyou or your employee's work at market rates.) Note that any expenditure prior to Innovation Connect Deed
Signature should you be successful in your application cannot be counted towards eligible project costs or matching funding.
Whatothergovernmentfundinghaveyou received?
Wordcount:
In no more than 500 words list all federal, state or local government funding your organisation has received in the last five years including any funding you are currently applying for
Budget
ProvideyourGSTExclusiveprojectbudget.Activitiesmustbeeligible(seeprogramguidelines)andyoumustbeabletoproveyouhavecompletedthem.
Activityitemdescriptionsmaybesomethinglike"BusinessPlanDevelopment","Websitedesign","Productcodingstage1","Producttesting"etc
"YourProjectContribution"mustatleastmatchthegrantfundingrequestedandmayinclude"in-kind"iethevalueofyouoryouremployee'sworkatreasonablemarketrates.
"InnovationConnect'sProjectContribution"mustbeoneligibleactivities,cannotinclude"in-kind"activitiesandshouldtotaltherequestedgrantamount.
ActivityBrief / ActivityCompletion / YourProject / InnovationConnect'sDescription / Date / Contribution / ProjectContribution
Suggested Milestone Schedule
Ifsuccessful,ICONwillpayuptohalfthevalueofthegrantuponcontractsignatureandtherestinarrearsofcompletedmilestones.
Suggestamilestoneschedulebelow.
MilestoneNumberMilestoneDescriptionCompletionDateICONPaymentAmount
CumulativeProjectExpenditure
Initial / $Final
Two payments, a first on contract signature and a final are preferred for administrative ease but add more if required. / These are definable moments in the project where key deliverables are achieved. / Must be a date / Must be a dollar amount / Total amount of project funds (Both yours and ICONs contribution) forecast to be spent by each milestone completion date. Final amount should equal the total project cost.
Total: / Total:
File Upload
Attachanyfilesrelvanttothis"YourInnovationConnectProject"hereincludingwhereavailable,quotesforthoseexpenditure(cost)itemsover$2000
Attachafile:
Maximum 25mb per file attachment. Recommended no more than 5mb per attachment.
Feedback,ReviewandSubmit
*indicatesarequiredfield.
Certification
Thismustbecompletedbytheapplicantorganisation.Icertifythat;
IhavereadtheIConFAQsGuidelinesandcompletedtheEligibilityChecklistonpage2ofthisformandtothebestofmyknowledgethisFormalApplicationiseligibleunderthosecriteria;
IunderstandandacceptthattheACTGovernmentmayberequiredtoliaisewithotherorganisations,including CommonwealthGovernmentDepartments,inrelationtoapplicationsforassistance.IagreetothereleaseofdetailedinformationbytheseorganisationstoofficersoftheACTGovernment;
Iunderstandandacceptthatshouldtheapplicationbesuccessful,aformalagreementwillneedtobeexecutedwiththeACTGovernmentpriortofunding;
Iunderstandandacceptthatiftheapplicationisofferedfunding,theprojecttitle,projectoutcome,totalcost,totaleligibleexpenditureanddetailsofthegrantsupportofferedmaybepublishedbytheACTGovernmentinmaterialforthepromotionofitsprogramsorinreportingrequirementstotheACTLegislativeAssembly;
Iunderstandthatallfundingsupportisprovidedonamatchedfundingbasis,andmayrequirepaymentinarrearsofsomecostsincurredbythegrantrecipient;
Iunderstandthatproofofexpenditurewillberequiredbeforemilestoneclaimsareapprovedandpaid;and
TheinformationprovidedinthisFormalApplication,includingattachments,istrueandcorrecttothebestofmyknowledge.
Iagree*YesNoResponserequired.
Privacy Notice
IncompliancewiththeInformationPrivacyAct2009(theAct)personalinformationonthisformmaybestoredinInnovationConnect’srecordsdatabaseandmayalsobeusedforstatisticalresearch,informationprovisionandevaluationofservices.Yourpersonalinformationmaybedisclosedtootheragenciesandthirdpartiesforpurposesrelatedtothisapplicationand/ormonitoringcompliancewiththeAct.Exceptinthesecircumstances,personalorcommercialinformationwillonlybedisclosedtothirdpartieswithyourconsentunlessotherwiserequiredorauthorisedbylaw.
Youarenowcomingtotheendofyourapplicationprocess.BeforeyouhitNEXTatthebottomofthispagetoREVIEWand
SUBMITpleasetakeafewmomentstoprovidesomefeedback.
Wewouldvalueanyfeedbackyoumayhaveregardingouronlinegrantsapplicationprocess.Pleaseindicatehowyoufoundtheonlineapplicationprocess:
VeryeasyEasyNeitherDifficultVerydifficultHowmanyminutesdidittakeyoutocompletethisapplication?
Please estimate in minutes e.g. 1 hour = 60 minutes
Pleaseprovideuswithanyimprovementsand/oradditionstotheapplicationprocess/formthatyouthinkweneedtoconsider:
No more than 100 words.
THANKYOU!