Application Form for the South Australian Collaboration Pathways Program commencing in 2012/13

Applications for the South Australian Collaboration Pathways Program can be lodged with the Department of Further Education, Employment, Science and Technology (DFEEST) continuously throughout the year. This application form must be completed and submitted electronically to . For applicants seeking funding in 2012/13, applications must be lodged before 8 March 2013. In preparing your application it is recommended that applicants carefully review the Program Guidelines with regards to eligibility, assessment criteria and application process. This program has two categories; please indicate below which category your application is seeking support for.

Please provide details of lead person representing this proposed collaboration

Name:
Position:
University/Institution:
Telephone:
Mobile (if applicable)
Email:
Postal Address
Category 1 – Collaborations in Development / Yes / No / Category 2 – Leveraging Support / Yes / No

Please provide the information for questions 1-4 in no more than six A4 pages and in the required format.

  1. Provide a short description (no more than 300 words) in plain English of the purpose and expected outcomes.

  1. What the Collaboration plans to deliver and a statement on impact (including milestones and key performance indicators).

  1. Details of the proposed Governance arrangements of the Collaboration and alignment with State and National Priorities.

  1. Funding and support for the Collaboration: (a) Detailed support to be provided by the Administering Organisation and local end user or industry partner. Please include; year of expenditure, source and purpose of funding, cash and value of in-kind contributions. (b) Total budget (including proposed PRIF contributions) and requested term of Collaboration (maximum 3 years).

Confirmation from Deputy Vice Chancellor Research (or equivalent)

  • I warrant that the information supplied in this application (including any supporting documentation) is true, and authorise the Government of South Australia and its employees or agents to undertake any reasonable checks on the veracity and quality of the information provided.
  • Protecting applicants’ confidential information is important to DFEEST. Information provided by applicants will be considered confidential and treated as such by DFEEST, the Assessment Panel and any third parties from whom advice is sought. Confidential information will only be released with the applicants’ agreement or when required by law.

Name: / Position:
Organisation:
Signature: <typing your name in this space constitutes an electronic signature for the purposes of this application>
Date:

You will be provided with an email confirming receipt of your application. Applicants may also be required to provide further advice (either in writing or by phone) in support of their application.

For Assistance contact DFEEST on (08) 8207 8702.

DFEEST/12/1638581