For office use only
Application #:
Date Received:
Alberta Innovates - Energy and Environment Solutions
(AI-EES)
Expression of Interest (EOI) Application Form –
Water Innovation Program
This form has been provided to you by AI-EES staff to assess the merits of the proposed
application and its fit with the mandate and strategic priorities of the Water Innovation Program
call for EOIs. If the EOI passes through a preliminary evaluation you may be asked to complete a
full project proposal. Please visit our website at www.ai-ees.ca/opportunities to learn more about
this call.
Email the completed form to: Dianne.White@albertainnovates.ca
Deadline for EOI submission - 3:00 p.m., MST on November 23, 2015
If submitting a signed hard copy, mail to:
Dianne White
Water Innovation Program
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.
1|Page
For office use only
Application #:
Date Received:
Project Title:
Project Location:
Anticipated Start Date:
Anticipated End Date:
Contact Information
Principal Investigator:
Title:
Organization:
Department:
Address:
Phone:
Email:
Fax:
Instructions


Using 8.5 x 11 paper, 12-pt font, in free-form text format, complete the following sections
(A to G) using a maximum of 8 pages. Signatures (section H) can be on additional pages.
Delete the text in [square brackets] which represents questions and instructions for each
section and replace it with your input.
2|Page
For office use only
Application #:
Date Received:
A. Project Summary and Relevance to Alberta
[Please provide the background and objective of the project, including the challenge/opportunity
being addressed. Explain the expected results and how the outcomes will impact water resources
sustainability in Alberta. The summary should be written in plain language.]
B. Research Status
[Please provide a brief description of the current status of your proposed research. What work has
been completed to date? Have any papers been published? If the research includes a technology,
has the proposed technology been patented (or patent applied for)? Who is the inventor? Who
would own new intellectual property generated within this proposed project? What are the
research gaps that this project will address?]
C. Project Partners
[Please list your project partners and describe their role in the project (e.g. researcher, subject
matter expert, etc.)]
D. Description of Project Team
[Please describe your project team, including the roles, responsibilities and time allocations of
each member. Identify the project champion.]
E. Description of Work Plan
[Please outline the proposed work plan that will achieve the project objectives. Provide a
description of the project scope, tasks, deliverables and schedule.]
F. Proposed Outcomes and Benefits to Alberta
[Please describe the expected outcomes of the proposed project. How will the outcomes address
investment priorities of the Water Innovation Program in Alberta? Identify any
policies/regulations that the project outcomes may inform or support.]
G. Project Funding and Budget
[Add columns and rows as required to fill out each table. All amounts should be in Canadian
dollars. Please indicate if the funds are committed or applied for.]
SOURCE
Cash
In-Kind
Amount Requested from AI-EES
$
Amount Supplied by the Applicant
$
Amount Supplied by Government(s) or third parties
- [Please list]
$
- [Please list]
$
TOTAL $
Item
Salaries and Benefits
Materials and Equipment
Year 1
$
$
Year 2
$
$
Year 3
% of Total
$
$
3|Page
For office use only
Application #:
Travel
Sub-contractor
Overhead
$
$
$
Total $
AI-EES $ (cash)
$
Applicant + Partners $ (cash)
$
Applicant + Partners $ (in-kind)
$
Date Received:
$
$
$
$
$
$
$
$
$
$
$
$
$
$
4|Page
For office use only
Application #:
Date Received:
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 AI-EES Call for Expressions of
Interest.
Principal Investigator’s Name
Title/Organization
Signature
Date
Authorized Representative’s Name
Title/Organization
Signature
Date
5|Page