HAWKESBURY INSTITUTE FOR THE ENVIRONMENT

RESEARCH EXCHANGE PROGRAM (OUTBOUND)

APPLICATION FORMCOMMENCING 2017

1. Applicant Details

Name
Role /  Academic Staff  Postdoctoral Fellow  Postgraduate Student
Contact Phone Numbers / Mobile:Work:
Email Address

2. Proposed Collaboration

Identify the nature of the collaboration commencing 2017( one only):

Program A – initiate a short term exchange of 1-3 months duration. The budget may include travel, living expenses (including accommodation) and minor research costs;

Program B – initiate a longer term exchange for up to 12 months’ duration. The budget may include travel, living expenses (including accommodation), and research costs.

3. Proposed Activities for Outbound Exchange

Name of Academic host / Name:
Contact (email):
Name of host University or Institution / Name:
URL:
Address:
Location  / NationalInternational
Brief overview of Academic host’s research experience and how it relates to the HIE
(max 100 words in 10pt Arial – attach and reference separate page if necessary)
Aims and significance of the proposed project
(max 100 words in 10pt Arial – attach and reference separate page if necessary)
Research Plan for the proposed project
(Approximately one page in 10pt Arial)
Expected outcomes of the proposed exchange
(max 100 words in 10pt Arial – attach and reference separate page if necessary)
Itinerary and Timetable for project (include approximate dates)
(the exchange must commence in 2017)
Potential return visits for ongoing projects (as appropriate commencing):
(please indicate if you intend to submit a subsequent application beyond 2017)
– NOTE 1 there is no guarantee that the HIE will fund subsequent visits and will take into account the outcomes achieved during earlier visits
– NOTE 2 lead hosts and the exchange recipients will be required to submit a brief report within twelve months of the conclusion of the first and each subsequent visit
 2018  2019  2020

4. Previous funding for Research Exchange

Have you previously received funds through the HIE Research Exchange Program or another UWS funded program such as IRIS?  / YesNo
If Yes, list year, amount received, and the outcomes that were achieved (including publications):

5. Estimated Budget and Justification

Item / Cost ($AUD)
Identify the nature of the collaboration ( one only):
Program AProgram B
Travel
(return journey) / $
Accommodation and Living Allowance
Identify a daily rate multiplied by the number of days. The Institute will contribute$76.57 per day (up to 21 days) for students and academic levels A-C, or $98.55 per day (up to 21 days) for academic levels D-E. We will then pay a maximum daily rate $50.00 per day thereafter to all applicants. / Rate 1 $
Rate 2 $
Other (specify to a maximum of $3,000)
(requests for consumables costs will need to demonstrate that funds are not available from other sources including grants and research allocations of the HIE academic/s) / $
Funding Requested / $
Self-funded contribution (if any) / $

Funding will only cover the cost of the visiting/travelling HIE academic and not their families. Funding above the nominated amount specified for each program will need to be met by the research funding of the academic.

6. Supporting Material Checklist

Have you attached a short justification for each budget item requested?  / YesNo
Have you attached a two page CVof the academic host?
• include publication statistics like H index, citations and total number of publications  / YesNo
Have you attached a short letter of support from your host institution? / YesNo
Have you attached a short letter of support from your HIE supervisor (required for postdoctoral fellows and HDR students only) / YesNo
Higher Degree Research Students must include a paragraph detailing how the exchange will align with the preparation of their thesis / YesNo

7. Applicant’s Signature

Applicant’s Signature: Date:

8. Attachments (optional)

Please provide further documentation or supporting material you deem appropriate, and reference it back to this application.

CLOSING DATE: Friday 16 September2016

Please forward this application and accompanying documentation to:

Institute Director via
David Harland

Institute Manager

Hawkesbury Institute for the Environment

Building R2, Room G.69, Hawkesbury Campus

Locked Bag 1797, Penrith, NSW, 2751

02 4570 1125 or

I approve this HIE Research Exchange Programfunding.

Name:

Signature: Date:

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