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 Page 3 of 7 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 Page 4 of 7 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 Page 5 of 7 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 Page 6 of 7 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 Page 7 of 7