Student Expression Of Interest Application Form

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Student Project Plan
Project Number
(CRC assigned)
SPX-XX
Is project linked
to a CRC Project?
Project Title
Max 6 words
Student
Is student has not yet been identified use TBA
Yes/No
Linked CRC
Project #
Project Leader/Primary
Supervisor
Secondary Supervisor(s)
Degree
Institution
Degree Commencement
Date
Degree
Completion Date
Project support
sought
Student Stipend sought
Stipend $
Total funding request
Total support $
Program Number
In-kind Value
Project support $
In-kind Contributions $
Program Leader
Project Summary
Less than 250 words of plain language (clinical need and relevance to research priority areas, objectives,
methodology, significance and innovative aspects of the expected outcomes, end user support,
potential of IP)
Responsible Participants, Project Participants, Project Contributions and Project Shares
Contribution Amount
Project Participant
(Institution, company)
Timing for
Contribution
Cash
In-kind
(If Tied Funds)
(if Tied Funds)
(if not part of
annual
Contribution)
Indicative
Project
Share
IP Owning
Project
(relevant to
Participant IP Owning
Y/N
Project
Participant
s)
Total
CRC central funds cash contribution requested
Project Leader Certification
I certify I have discussed this Project with the CEO and the Project Participants. I understand the
responsibilities of the Project Leader role and have the time and capacity to perform the role of Project Leader.
Name:
Signature:
Date:
Student Participation
I certify that I have discussed this Project with the Project leader. I understand the responsibilities of my role
and have the time and capacity to perform the role as a student.
Student Name:
Student
Signature:
Date:
1 Project Objectives
Describe the objectives of the project – up to 5 bullet points
2 Proposed Strategy – Research Methodology
Describe the proposed strategy and methodology, including the responsibilities of Participants– Max 750
words (suggested headings: conceptual framework, methodology, role or participants, brief references)
3 Potential Outputs and Outcomes
Describe the potential outcomes – up to 5 bullet points
4 Analysis of Project Risk
Describe any risks associated with this project and how they are to be mitigated – Max 250 words
5 Analysis of project impact
Describe the benefits that the project will have on end users and in what timeframe and how it differs
from competing approaches– Max 250 words
6 Project Milestones/outputs
Project Milestones/Outputs
Responsible
Person/Organisation/Participant
Date Due
Milestone
related to in
Commonwealth
Agreement
(Ref #)
1
Student enrolled
Student/institution
3 months
CRC will input
2
WMI CRC IP Training
Student/WMI CRC
1 year
3
GLP/GCP introductory training as
relevant
Student/WMI CRC
1 year
4
Progress report #1
Student/Supervisor
June 30 yr
1
5
Student confirmation approved
Student/institution
1 year
6
Progress report #2
7
Progress report #3
8
Student/Supervisor
Dec 31 yr 1
Student/Supervisor
June 30 yr
2
Progress report #4
Student/Supervisor
Dec 31 yr 2
9
Progress report #5
Student/Supervisor
June 30 yr
3
10
Progress report #6
Student/Supervisor
Dec 30 yr 3
Student Project Plan V2.2 Jan 2015
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11
Thesis submitted
Student/Supervisor
3 years
CRC will input
7 Utilisation
The WMICRC Pty Ltd will act as the default utilisation agent.
8 Background IP
Is there IP owned either by the Research Institute, other Project Participant or an entity not involved in the
project which is required for the project?
Name of party making
Owner of Background
Restrictions on use of
Description
the background IP
IP
Background IP
available (if not owner)
9 Project Deed Polls
Have(confidentiality agreements/IP assignment) been completed for all staff and students involved in the
Project?
Yes/No, if no outline schedule to obtain ethics
10 Are Moral Rights Waiver forms required for any project personnel for this
Project?
Yes/No
and if so have they been completed?
Yes/No
11 Have the appropriate ethics approvals been sought and granted for this
Project?
Yes/No
12 Special Conditions
13 Project Budget:
Participant Institution
Budget Item
Financial
year
FTE %
31/3/15
30/6/15
Total
Student stipend
Student operating
FY14/15
TOTAL
Student Project Plan V2.2 Jan 2015
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FTE %
30/09/15
31/12/15
31/3/16
30/6/16
Total
FTE %
30/09/16
31/12/16
31/3/17
30/6/17
Total
30/09/17
31/12/16
31/3/17
30/6/17
Total
Student stipend
Student operating
FY15/16
TOTAL
Student stipend
Student operating
FY16/17
TOTAL
FTE %
Student stipend
Student operating
FY17/18
TOTAL
14 Resource Requirements
1.
FTE in-kind contributions
Project Participant
(Institute, company etc)
Level
Name
SM, KR,
RP, SS
% Time
Start
Date
Finish
Date
In kind value
Total FTE in-kind contributions
*Level indicates one of the 4 levels provided by the Commonwealth
SM = Senior Manager - $380K per annum
KR = Key Researcher/Project/Theme Leader/Manager - $260K per annum
RP = Researcher/Professional - $200K per annum
SS = Other Support Staff (Technical/Administrative etc) - $160K per annum
2.
Non-staff in-kind contributions (infrastructure support for CRC centre funded staff):
Participant (Institute, company
etc)
3.
Agreed $ value (based on 1.25 times salary plus salary on-costs)
Other in-kind Contributions (for use of equipment, laboratories, etc):
This section is intended to capture extraordinary in-kind expenses (eg. equipment hire, infrastructure access
costs, internal equipment charges etc.), and where those expenses were foreshadowed as an in-kind
Student Project Plan V2.2 Jan 2015
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contribution in the Participants Agreement. This must be made clear, as Participants will be acknowledging
these costs when signing the agreements.
15 Student Details
Provide details of the student involved in this Project detailing qualifications, the anticipated contribution by
the student regarding their research and time commitments, source and status (applied, approved etc.) of
student support, and any conditions attached to support.
16 Contributions to be made by third parties
Enter details of third party and a description of their contribution. A third party is a non-CRC
Participant
17 Project performance and responsibilities are outlined in the Participants
Agreement
The Project Leader is the person appointed to act as a leader of a Project. The Project Leader and
Participants must maintain the appropriate financial, research and technical records
The Project Leader must:
 Ensure compliance with OH&S, animal ethics, human research ethics legislation and organisational
obligations
 Ensure research is conducted in a ethical manner as described by the NH&MRC and the ARC
 Ensure that clinical trials are conducted using Good Clinical Practice
 Use his or her reasonable efforts to ensure the Project is conducted in accordance with the Project Plan to
achieve the Milestones and Project Objectives
 Be responsible for administration of the Project and liaison with Responsible Participants
 Ensure project funds for the purposes of the Project only
 Ensure project funds are used in accordance with the Project Plan and project budget
 Provide quarterly reports to the WMI CRC on Project progress against milestones/outputs, deviations from
the Project plan, any significant difficulties encountered and any Project IP created
Student Project Plan V2.2 Jan 2015
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Form Instructions (please delete this section prior to submission):
Font – calibri 11, black, standard (non-italics) with standard line and character spacing/kerning. Margins –
min Form Instructions (please delete this section prior to submission):
Font – calibri 11, black, standard (non-italics) with standard line and character spacing/kerning. Margins –
minimum of 2 cm. Please delete the instructional text in each box which is in grey italics.
Please refer to the WMI CRC’s Research Priorities document during the preparation of your application.
Applications should be submitted to research@woundcrc.com by 11.59 pm Wed 11th Feb 2015. Queries
can also be submitted to this e-mail address at any time and a phone hotline will operate 2-4 pm on Thurs
5th and Tues 10th on 07 3138 4899 to assist with form filling enquiries.
Please submit applications as both word and pdfs. The pdf will be used for review, and the word document
will form the basis of the contract between the CRC and Participant institution if the application is
successful.
Projects for studentships must be submitted on this Student Application Form and students will need to
complete their PhDs by June 30th 2018. This is the last funding opportunity for students starting their PhDs.
Masters and Honours projects will continue to be considered at later dates via the Student Application
Form but can also be submitted for consideration on Feb 11th.
The CRC funds PhD students for a maximum of 3 years providing $7000 p.a. as a top-up student stipend and
$15,000 p.a. in operating costs. Students who have already started their PhD will receive funding up to the
equivalent of 3 years full time from enrolment. E.g. John Doe started his PhD on 1st Feb 2014, full time. He
receives a PhD scholarship from the CRC on 1st March 2015, so he will be eligible for 1 yr and 11 months of
PhD scholarship. For Masters and Honours Students a $5000 scholarship plus operating funds of $7,500
p.a. is available.
If a student is already enrolled, assume a start date of 1st March 2015 for the CRC scholarship.
Round all budget figures to the nearest dollar.
It is a condition of funding that students sign a deed poll assigning their IP rights either to the University or
to the CRC.
Student Project Plan V2.2 Jan 2015
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