For office use only
Application #:
Date Received:
Alberta Innovates-Energy and Environment Solutions
(AI-EES)
Expression of Interest (EOI) Application Form –
Water Resources Sustainability
This form has been provided to you by AI-EES staff to assess the merits of the proposed
application and its fit with AI-EES’ mandate and strategic priorities. If the EOI passes through a
preliminary evaluation you may be asked to complete a full project proposal. Please visit our
website at http://ai-ees.ca to learn more about our strategic directions.
Email the completed form to: jon.sweetman@albertainnovates.ca
A signed hard copy should also be mailed to:
Jon Sweetman
Manager, Water Resources
Alberta Innovates: Energy and Environment Solutions
18th Floor, Phipps McKinnon Building
10020 – 101A Avenue
Edmonton, Alberta T5J 3G2
The personal information on this form is collected pursuant to the Freedom of Information and
Protection of Privacy Act (FOIP Act) and is used for evaluation of grant applications. Portions of
this information may be published on our website if the grant application is successful. If you
have any questions regarding the collection of information on this form, please direct your
inquiries to Alice Barr, Director, Strategic Planning and Operations, Alberta Innovates - Energy
and Environment Solutions (AI-EES), Suite 2540, 801 - 6th Avenue SW, Calgary, Alberta, Canada,
T2P 3W2 (403) 297-8650.
Project Title:
Project Location:
Anticipated Start Date
Anticipated End Date
Contact Information
Principal
Investigator:
Title:
Organization:
Department:
Address:
Phone:
Email:
Fax:
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Application #:
Date Received:
Using 8.5 x 11 paper, in free-form text format, complete the following sections, A-D (Maximum 6
pages)
A. Project Summary and Relevance to Alberta:
Please provide the background and objective of the project, explain the expected results, and how
the outcome will impact the water resources sustainability in Alberta. Note: Summary should be
written in plain language, and will be made available to the public if your proposal is funded.
B. Technology Status:
If your proposal is a technological development, please provide a brief description of the current
status of your proposed technology. Has the proposed technology been patented (or patent applied
for)? Who is the inventor? Do you own the patent? If you do not own the intellectual property
how have you gained access to it? Who would own the new intellectual property generated within
this proposed project?
Technology Readiness Level (Choose one only)
Applied – Basic Research
Basic principles observed and technology concept and/or
application formulated
Proof-of Concept
(technology assessment)
Physical and analytical “proof-of-concept” via laboratory
studies and analysis
Technology Development
Technology developed and tested at a small scale, with
independent expert verification and validation
Technology
Demonstration
Technology demonstrated at intermediate or field scale
Full Production Mode
Commercial technology, with potential improvements possible
C. Description of Research Team
Please describe your research team, including the roles, responsibilities and time allocations of
each member.
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Application #:
Date Received:
D. Organizational and Business Readiness Level
Senior Management Champion (name & title)
For technology development projects, provide
Business Case Status (tick one)
None
Preliminary
Full
Access to Technical Resources and
Infrastructure (tick one)
R&D
Pilot
Demonstration
Applied For
Partial
Fully
Committed
Internal Resources to Invest in the Project
(tick one)
E. Description of Workplan:
Please provide a description of the project scope, tasks, and schedule
F. Proposed Milestones and Deliverables:
Please describe key milestones and deliverables
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Application #:
Date Received:
G. Projected Budget
SOURCE
Amount Requested from AI-EES
$
Amount Supplied by the Applicant
$
Amount Supplied by Government(s) or third parties (please list)
$
- Alberta Government
$
- Federal Government
$
- Other Government
$
- Other Colloborator/Partner
TOTAL $
Item
Salaries and Benefits
Materials and Equipment
Travel
Sub-contractor
Overhead
Total
Collaborator/Partner $
[cash]
Collaborator/Partner $
[in-kind]
Amount Requested
from AI-EES
Year 1 $
Year 2 $
Cash
Year 3 $
In-Kind
% of Total
H. Signatures and Authorized Representative
By signing as representatives of the lead applicant’s employing organization, the undersigned
hereby verify acceptance of the terms and conditions of the Alberta Innovates- Energy and
Environment Solutions programs.
Principal Investigator’s Name
Title/Organization
Signature
Date
Authorized Representative’s Name
Title/Organization
Signature
Date
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