2016 Science and Innovation Awards for
Young People in Agriculture, Fisheries and Forestry
APPLICATION FORM
Applications close at 5.00pm AEDT
Friday 09 October 2015
Applicants should read the material available on the Science and Innovation Awards website, including the Information for Applicants and be familiar with the assessment criteria on which applications will be judged, prior to completing this form
For further information
Visit: www.agriculture.gov.au/scienceawards
Email:
Phone: 02 6272 2260 / 6272 2303
APPLICATION CHECKLISTPlease review and complete the following checklist. If you answer “No” to any of the above questions, you are not eligible for the 2016 Science and Innovation Awards.
1. / I have read and understood the material on the Science Awards website including the Information for Applicants for information regarding eligibility, specific project requirements and lodgement details, and completed all sections of this form. / Yes / No2. / I am aged between 18 and 35 years (inclusive) by the closing date. / Yes / No
3. / I am an Australian citizen or permanent resident of Australia and have enclosed documentary proof / Yes / No
4. / My project demonstrates innovation in scientific or technological approach or process and is related to a significant, long standing or emerging issue in agriculture, fisheries or forestry related industry. / Yes / No
5. / My project demonstrates dedication to the future of rural and regional industries with a commitment to promoting science and innovation. / Yes / No
6. / I confirm that my project proposal is not my PhD project. / Yes / No
7. / My project budget is a maximum of $22,000 (incl GST). / Yes / No
8. / My project will commence after the funding agreement is executed and is expected to be completed within 12 months from the execution date. / Yes / No
9. / I confirm that my project has not received funding of any kind from a Commonwealth or State Government department. / Yes / No
10. / I confirm that I am not currently employed by a Non-Corporate Commonwealth Entity. / Yes / No
11. / I confirm that I am not currently employed by an Award sponsor in the category I am applying for. / Yes / No
12. / I confirm that I do not have an immediate family member (eg. a parent or sibling) who is employed by an Award sponsor in the category I am applying for. / Yes / No
13. / I confirm that my host organisation (my employer) is aware of my application. / Yes / No
Double click the grey check box and select “checked” from the menu box
If in doubt, contact the Science Awards team at or
02 6272 2260 / 6272 2303.
Title
First name
Surname
Date of Birth (dd/mm/yyyy)
Postal address inc. city state postcode
Home address inc. city state postcode
Phone work
Phone home
Mobile
Your current occupation
Your current employer *
Period with current employer
Employer address inc. city state postcode
Citizenship (please tick)** / I am an Australian citizen
I am a permanent resident of Australia**
** If you ticked this box please ensure you include appropriate documentation.
* applicants should be aware that if successful, the Department of Agriculture will enter into a funding agreement with the employer, on behalf of the applicant, as the grantee.
SECTION B – INDUSTRY AWARD CATEGORY
Please nominate your Industry Award category (tick one box only). If you wish to apply for more than one category, please submit a separate application.
Award Award sponsor
Viticulture and oenology / Australian Grape and Wine AuthorityRed meat processing / Australian Meat Processor Corporation
Pork / Australian Pork Ltd
Wool / Australian Wool Innovation
Cotton / Cotton Research and Development Corporation
Health and biosecurity / CSIRO Health and Biosecurity
Dairy / Dairy Australia
Fisheries and aquaculture / Fisheries Research and Development Corporation
Grains / Grains Research and Development Corporation
Meat and livestock / Meat & Livestock Australia
Established, new and emerging rural industries / Rural Industries Research and Development Corporation
SECTION C – PROJECT PROPOSAL
Describe your proposed project for this grant. The period of the grant project is 12 months from signing a funding agreement, so your timeframe should focus on your project activities in this period.
Please do not exceed four pages in total excluding the project costing table.
1. Project title (maximum 20 words)
2. Overview of the project (maximum 100 words)
3. Objectives of the project You may wish to consider these questions in your answer (maximum two pages)
a. Why is this project needed / important? Be clear in your explanation of the industry significance.
b. How is the project innovative, different or distinct (e.g. from current methods being used by industry)?
c. What are the anticipated benefits the project will bring to your industry?
d. What are the anticipated benefits the project will offer you personally?
4. Description of the project activities
a. What activities will be conducted by you as part of the project? (maximum one page)
b. What are the proposed timeframes and key milestones of the project? (Add more lines if required)
Milestone/activity / Start/end dates**Project should not start until a funding agreement is signed. Projects are to be completed within 12 months.
5. Knowledge sharing (maximum half page)
Outline your plans for sharing your knowledge and experience gained in conducting the project, including details of the target audience(s) relevant to your industry.
6. Project costing
Provide a detailed costing to a maximum of $22,000 inc gst, by listing anticipated costs under separate headings. You may adjust headings to suit. Ensure that accurate figures are entered as whole dollar amounts only and the total project cost is correct.
ITEM DESCRIPTION / TOTAL COST(incl GST)
Equipment
Training/development/study
Publication
Meetings
Other
TOTAL PROJECT COST inc GST / $
SECTION D – PERSONAL ACHIEVEMENTS
Please provide a brief summary of your achievements to date related to your work, study (including your PhD status ie planning to study, currently studying, have a PhD or n/a) or rural community involvement (limit of two pages).
SECTION E – REFEREE REPORTS
The referees should be currently working, or have recently worked, in a related field and must be familiar with your project proposal.
REFEREE ONE
Referee nameRelationship to applicant
1. Outcome and benefits – please specify how the applicant’s project would benefit industry:
2. Communication and extension – please comment on the applicant’s ability to communicate the outcomes of this project to industry and other stakeholders, and the likely personal and career benefits to the applicant:
Referee’s position and employerDaytime phone and mobile
Referee’s signature
REFEREE TWO
Referee nameRelationship to applicant
3. Outcome and benefits – please specify how the applicant’s project would benefit industry:
4. Communication and extension – please comment on the applicant’s ability to communicate the outcomes of this project to industry and other stakeholders, and the likely personal and career benefits to the applicant:
Referee’s position and employerDaytime phone and mobile
Referee’s signature
SECTION F – PRIVACY
Personal information means any information or opinion about an identified, or reasonably identifiable, individual.
The collection of personal information by the department in relation to this application form is for the purposes of assessing eligibility of an application for the Science and Innovation Awards for Young People in Agriculture, Fisheries and Forestry programme and related purposes. If the relevant personal information requested in this application is not provided, the department will be unable to assess an application’s eligibility for this programme.
Personal information provided to the department is for the purposes of administration or evaluation of the programme and application assessment. In providing personal information, applicants consent to the department using the information for the above mentioned purposes and other related purposes.
Personal information may be disclosed to relevant parties engaged for the purposes of application assessment and programme evaluation, such as departmental staff, staff of the Award sponsors, judging panel members, the Minister and the Minister’s office, on the department’s website and to other Australia government agencies, persons or organisations where necessary for the above purposes.
Specifically, you may be contacted by the department to discuss and progress your application for the Science Awards round. If you are successful, your project details, biography and photographs will be used for promotional purposes related to the Awards, including media releases and other promotional material, inclusion on the ABARES and sponsors’ websites and through social media including Twitter and Facebook.
You should also be aware that if successful, Commonwealth policy requires the department to publish information on its website about the grant, including, but not limited to:
· Name of the recipient of the grant
· Purpose of the grant funding
· Amount of funding received
· Term of the grant and
· Location.
All disclosure of your personal information will be consistent with relevant laws, in particular the Privacy Act 1988. Personal information will be used and stored in accordance with the Australian Privacy Principles.
By submitting this application, I consent to publication of the above information by the department, if I am awarded funding. I hereby consent to such disclosure:
Yes No
For reference, current grant reporting requirements can be viewed at www.agriculture.gov.au/about/obligations/grants-reporting-requirements
The department’s Privacy Policy can be found at www.agriculture.gov.au/about/accessing-information.
To contact the department about personal information or to make a complaint:
Telephone: Switchboard +61 2 6272 3933
Email:
Post: Privacy Contact Officer, Department of Agriculture, GPO Box 858, Canberra ACT 2601.
In the first instance, if you require further information or have queries regarding the use of your personal information as part of the programme, please contact us at .
SECTION G – DECLARATION
By signing below, I acknowledge that:
- I have read and understood the 2016 Science and Innovation Awards for Young People in Agriculture, Fisheries and Forestry Information for Applicants.
- I have included details of any known or potential conflict of interest below.
- I agree to the publishing of personal information as noted in Section F – privacy.
- The information provided in this application is true and correct[1]..
Details of conflict of interest
Dated this day of [insert year]
Signature of applicant / Signature of witnessName of applicant (print) / Name of witness (print)
Note: witnesses must be over 18 years old and not related to the applicant.
SECTION H – FEEDBACK (optional)
We would appreciate knowing how you found out about the [insert year] Science Awards. This section is optional and does not form part of your application or assessment so you may opt to leave it blank.
Newspaper / Name of paperSocial media / ABARES Twitter or Facebook
Website / Website address
Award sponsor / Information from Award sponsor (name)
Email newsletter / Details of email newsletter/sender
Other / Please specify
Radio/TV / Name of radio/TV
SECTION I – APPLICATION LODGEMENT
Applicants are to email the completed application to .
Applications must be received by 5.00pm AEDT Friday 09 October 2015
For enquiries:
Science Awards Manager
Department of Agriculture
GPO Box 858
CANBERRA ACT 2601
Email -
Phone – 02 6272 2260 / 6272 2303
Thank you for your interest and application for the 2016 Science and Innovation Awards.
[1] Intentionally giving false or misleading information is an offence under the Criminal Code Act 1995 (Cth).