Research Funding Clearance Form
Project type (please select one)
Grant: ☐
For more information see Applying for Funding
Contract Research: ☐
Consultancy: ☐
Tender: ☐
Clinical Trials: ☐
Project details
Project Title:
Describe your project:
HERDC research requirements Describe the original research or new outcome (refer HERDC spec 3):
Proposed funding commencement date:
Grants
Proposed funding completion date:
Funding Body:
Scheme (e.g. Linkage Project):
Funding Body name (if different from client):
Contract Research
Consultancies
Tenders
Clinical Trials
Client name:
ABN/ACN:
Contact name:
Position:
Address:
State:
Email:
Postcode:
Phone:
Who will be supplying the contract?
UTAS ☐
Client ☐
To be determined ☐
Chief Investigator to whom correspondence will be sent. Students cannot be the first CI
Name (and title):
FTE Equivalent % (on project)
Discipline or Unit:
FTE:
Other UTAS researchers who have intellectual carriage and responsibility for this project
Name 2:
Discipline or Unit:
FTE:
Name 3:
Discipline or Unit:
FTE:
Name 4:
Discipline or Unit:
FTE:
Other external researchers who have intellectual carriage and responsibility for this project
Name 5:
Organisation:
Name 6:
Organisation:
Name 7:
Organisation:
Voluntary position holders
A Deed of Assignment may be required
Name/s:
Discipline or Unit:
Voluntary person involved: No ☐
Yes ☐
Type of involvement: Associated with project/unpaid ☐
Paid from Project – casual employee ☐
Higher Degree Research students
Student involved: No ☐
A Deed of Assignment may be required
Yes ☐
Name/s:
Type of involvement: Associated with project/unpaid ☐
Discipline or Unit:
Paid from Project – casual employee ☐
Research Codes and Strategic Research Priority areas
Field of Research (FOR)
code(s) (6 digits)
Total
%
100%
Socio-Economic Objective
(SEO) code(s) (6 digits)
Total
Scholarship paid from Project ☐
For assistance, go to Classification codes
Strategic Research
Priority Area(s) (2 digits)
%
100%
Total
%
100%
Type(s) of
Activity (TOA)
Applied Research
Experimental
Development
Strategic Basic
Pure Basic
Total
Ethics Information
%
100%
For assistance, go to Integrity and Ethics
Does your research involve:
Have you applied for ethics approval?
Human participants (medical)
No ☐
Yes ☐
No ☐
Yes ☐
Human participants (social science)
No ☐
Yes ☐
No ☐
Yes ☐
Animals (vertebrates and/or cephalopods)
No ☐
Yes ☐
No ☐
Yes ☐
Genetic manipulation
No ☐
Yes ☐
No ☐
Yes ☐
Carcinogenic/Teratogenic Substances
No ☐
Yes ☐
No ☐
Yes ☐
Ionising Radiation
No ☐
Yes ☐
No ☐
Yes ☐
V 1_12 Last updated 31/3/2016
Approval/ application no.
Project costs (complete each line as applicable)
For assistance, go to Budget Preparation
Amount requested from Funding Body
$
Includes UTAS indirect project costs (UTAS overheads)
$
Includes Profit (consultancy only) Paid to CI: No ☐ Yes ☐ or Paid to School/Institute: No ☐ Yes ☐
$
In-kind contribution (not cash)
UTAS
+$
Other organisation – Name/s:
+$
Cash contribution
UTAS – School/Institute/Faculty
+$
UTAS – DVCR
+$
Other organisation – Name/s:
+$
Total project costs (actual cost of project)
=$
Is UTAS the administrating organisation? No ☐ Yes ☐ If no, what is the UTAS share of the amount requested from Funding Body?
$
If no, who is the administrating organisation? Please specify:
External payments
Will any of the project work be conducted by a third party (eg. external contractor, other university)?
No ☐ Yes ☐
Name of third party/ies:
Cash to be paid to third party/ies:
$
Facilities and Infrastructure
No ☐ Yes ☐
Do you require any internal UTAS facilities eg. Central Science Laboratory, Aquaculture Centre?
If yes, please ensure that you have booked the facility and you have added it to your costing tool.
Chief Investigator (CI) endorsement
If multiple School/Institute/Centres are included below, both CIs must sign this form
Has a Risk Assessment been undertaken?
I am satisfied that the risks identified within this project will be appropriately managed.
No ☐
No ☐
Yes ☐
Yes ☐
Is the project covered by UTAS insurance?
Will the research involve an item subject to controls under the Defence and Strategic Good List, and
involve an export, supply, brokering or publishing activity? For assistance, go to Defence Trade Control
No ☐
Yes ☐
No ☐
Yes ☐
Is there, or could there be, a potential conflict of interest?
CI SIGNATURE:
Yes ☐
DATE:
No ☐
Unsure ☐
If yes, please provide further detail:
CI SIGNATURE:
DATE:
Head of School (HoS) or HoS delegate / Dean endorsement
If multiple organisational units (schools/institutes/centres) are included below, all HoS must sign this form.
Credit split will determine how block funding will be distributed between organisational units.
I agree:

that all project costs (direct and indirect) and all UTAS cash and in-kind contributions have been correctly included;

to fund any shortfall in the project costs if the project costing is insufficient (consultancies/research contracts only) ;

that the project can be accommodated within the general facilities in my School and sufficient working and office space will be available for
staff;

I am prepared to have the project carried out in my School under the circumstances set out by the researcher/s ;

I have noted the amount of time that the investigator/s will be devoting to the project and agree that it is appropriate to existing workloads;

I am satisfied that the project is adequately insured by the UTAS insurance policy;

I am satisfied that the Risk Assessment identified within this project will be appropriately managed during the course of the project; and

I am aware of the Conflict of Interest policy and my responsibility in the process.
Please note: The Org. Unit split nominated below is used to determine the distribution of research block grant funding and/or in-direct costs
ORGANISATIONAL UNIT 1:
% SPLIT
HOS NAME AND SIGNATURE:
DATE:
ORGANISATIONAL UNIT 2:
% SPLIT
HOS NAME AND SIGNATURE:
DATE:
IF THE HOS IS THE CHIEF INVESTIGATOR, ENDORSEMENT MUST BE MADE BY THE DEAN:
V 1_12 Last updated 31/3/2016
DEAN SIGNATURE
DATE
Checklist – Please scan and email the completed form to your Research Hub along with the below
A copy of the application
A UTAS Costing Tool
A copy of ethics approval (if applicable)
A purchase order (if applicable)
A copy of a draft contract (if applicable)
A copy of the guidelines (if applicable)
V 1_12 Last updated 31/3/2016