British Columbia Knowledge Development Fund (BCKDF) Application Form - Step 1 Basic Information and Alignment with British Columbia Priorities 1. TITLE Date submitted Applicant Institution Project Title CFI Competition Choose an item. Other - specify CFI File Number Enter CFI application number 30 January 2000 Identify lead applicant institution Enter full project title 2. LEAD RESEARCHER Name Faculty Department Last Name First Name Specify centre/institute where research will occur Faculty Centre/Institute: Department (e.g. IRMACS; TRIUMF; Djavad Mowafaghian Centre for Brain Health; etc.) 3. PROJECT FUNDING SUMMARY Upon notification of CFI’s Board decision to award a project unconditional or partial funding, institutions will be requested to submit additional financial information (BCKDF application - Step 2). See BCKDF Guidelines for more information. BCKDF funding is a restricted capital contribution for the development of a capital project as per Public Sector Accounting Standards. BCKDF does NOT fund operation and research costs. Table 1 Funding Source 1. BCKDF funding requested (maximum 40% of total eligible project budget) 2. CFI funding requested 3. Amount Contributions from other eligible partners (sum lines a. to c.) % Contribution $0.00 0% $0.00 0% $0.00 0% a) Applicant Institution $0.00 b) Other partners - Cash contributions $0.00 c) Other partners - In-kind contributions $0.00 Total project budget (sum lines 1 to 3) $0.00 4. PROJECT LOCATION This is a multi-institution project yes/no 100% This is part of a larger national project yes/no Part or all of infrastructure is located outside BC yes/no Part or all of infrastructure is located outside Canada yes/no Infrastructure Choose a campus Additional location 1: Additional location 2: Additional location 3: Specify institution & city Specify institution & city Specify institution & city location(s): Specify other or off campus location 5. CONSTRUCTION AND RENOVATION The requested infrastructure contains a building renovation or construction component? If yes: Total renovation or construction cost of the project: $0.00 Total area: yes/no Gross square meters Name of the building to be built or renovated 6. PRIORITY SECTOR Which provincial priority sector is this project the most closely associated with? Choose a priority sector Choose an item. If you chose “Other”, please specify here and explain how this sector aligns with BC Government priorities (max 150 words) Updated April 2015 BCKDF Step 1 Application Form BCKDF@gov.bc.ca Page 1 of 7 CFI File Number Lead researcher Enter CFI file number Last name 7. INFRASTRUCTURE PROJECT BRIEF Using simple, concise sentences describe in no more than five lines the objective and key elements of this proposal. Define the main benefits for British Columbia. This section may be used, in whole or in part, in press releases or similar material. Type your text here 8. STRATEGIC VALUE AND RESEARCH PRIORITIES FOR BRITISH COLUMBIA Within the frame in the next two pages, and for each of the four categories below, highlight the strategic value and benefits of your proposed project and requested infrastructure for British Columbia. Please be concise and use plain language. Subsections and bullets are acceptable. While applicants must address all four categories, they are encouraged to emphasize those which are most relevant to their project. Add one page if necessary. 8.1 Commercialization Describe the potential for commercialization resulting from the research conducted with the requested infrastructure (e.g. potential for spinoff companies, patents, interest from industry or potential users, etc.). Highlight the degree of involvement of the research project with industry or commercialization stakeholders (e.g. direct industry funding or in-kind contribution, investors’ interest, relation with commercialization programs, working collaborations). Commercialization may relate to research results, tools or processes enabled by the requested infrastructure. 8.2 Talent development Summarize how the infrastructure will enhance the current training environment for Highly Qualified Personnel (HQP), and show how it will prepare HQP for research and other careers. Include statistics on number of HQP expected to work on the research project with the requested infrastructure. HQP include researchers, post-doctoral fellows, doctoral students, masters students, technicians, professionals, and trainees who conduct research with the requested infrastructure. 8.3 Job creation Describe how and to what extent the research project and the requested infrastructure will contribute to job creation in British Columbia. This may include quantifying and specifying direct job creation (e.g. new researchers, technicians, support staff and students who will work on the project, jobs created for the construction or installation of the requested infrastructure), or demonstrating how the project may contribute to additional indirect employment in the province, for example as a result of commercialization or application of research outputs. 8.4 Other economic and societal benefits Describe other benefits for British Columbia that the investments in the infrastructure could generate. This may include social benefits, health benefits (e.g. reduced mortality and morbidity), economic benefits (e.g. reduced cost of public intervention and mitigation, enhanced competitiveness of the province), or international scientific reputation of the institution. If part or all of the requested infrastructure is located outside of British Columbia, or if this is a portion of a larger national project, clearly state the benefits for the province in a separate paragraph. Updated June 2015 BCKDF Step 1 Application Form BCKDF@gov.bc.ca Page 2 of 7 Type your text here for 8.1; 8.2; 8.3; and 8.4 Updated June 2015 BCKDF Step 1 Application Form BCKDF@gov.bc.ca Page 3 of 7 Type your text here Updated June 2015 BCKDF Step 1 Application Form BCKDF@gov.bc.ca Page 4 of 7 9. PROJECTS WITH A CONSTRUCTION OR RENOVATION COMPONENT Projects with a construction or renovation component may be required to submit additional information, dependent upon project scope, budget or assessed risk level. Ministry staff will contact an institution on a case-by-case basis. Please refer to the BCKDF Guidelines for additional information. Please concisely describe the scope of the renovation or construction work to be undertaken. Explain the necessity for the construction or renovation. Bullets are acceptable. If necessary, plans or other visuals should be appended separately. Type your text here Updated June 2015 BCKDF Step 1 Application Form BCKDF@gov.bc.ca Page 5 of 7 10. APPLICANT AND PARTNER INSTITUTIONS CONTACT INFORMATION Lead B.C. institution Name of Lead Applicant Institution Contact Person Address of Institution Email City Postal code Telephone number If this is a multi-institutional project, please list institutional partners and contact names below Lead institution on CFI proposal (if different from BC lead institution) Name of Lead Applicant Institution Contact Person Address of Institution Email City Postal code Telephone number Partner institution Name of Lead Applicant Institution Contact Person Address of Institution Email City Postal code Telephone number Partner institution Name of partner institution Contact Person Address of Institution Email City Postal code Telephone number Partner institution Name of partner institution Contact Person Address of Institution Email City Postal code Telephone number Partner institution Name of partner institution Contact Person Address of Institution Email City Postal code Telephone number B.C. lead institutional contact for regular correspondence Please provide a coordinator contact at the lead applicant institution for day-to-day correspondence regarding this application. Updated June 2015 Contact Person Email BCKDF Step 1 Application Form BCKDF@gov.bc.ca Telephone number Page 6 of 7 11. BCKDF APPLICATION CHECKLIST Please ensure that you have all the following documents appended to your BCKDF Application. Required BCKDF completed application form Attached signatures page (scans or electronic signatures accepted) Appended full CFI application 1 Optional Letters of commitment from all project funding partners, where funding is confirmed. SIGNATURES This application must be signed by the President, CEO, chair or other designate, of all B.C. applicant institutions. In the case of joint or multi-partner applications, the president, CEO, chair, or designate of each B.C. applicant institution must also provide signatures. For national projects, signatures are not required for co-applicants from outside of B.C. The undersigned: Acknowledge that the information and documentation provided is correct and may be shared with Ministry staff and others for the purpose of administering the BC Knowledge Development Fund; Agree to and accept the conditions governing the BCKDF funding, as outlined in the BCKDF Guidelines; and, Accept the commitment to ensure appropriate resources are provided for the operation and maintenance of the proposed BCKDF-funded research infrastructure over its useful life. ....... ....... Name and Title (Please Print) ....... Signature ....... Name and Title (Please Print) ....... Name and Title (Please Print) ....... Institution ....... Signature ....... Name and Title (Please Print) ....... ....... ....... Institution ....... Signature ....... Date Date ....... Institution ....... Signature Date ....... Institution Date Add pages if necessary 1 For Cyberinfrastructure Challenge 2 competition please contact the BCKDF coordinator. Updated June 2015 BCKDF Step 1 Application Form BCKDF@gov.bc.ca Page 7 of 7