Funding application for researchers from less developed countries Please provide details, or type ‘Yes’ in the appropriate box. Applications exceeding specified word limits will be declined. Applications must be typewritten and sent electronically as one PDF document. To be eligible, you must be a researcher who is currently employed by an institution of a less developed country and be based in that country. This application must have your supervisor’s support. Your Details Full name: Nationality: Gender: Postal address: Phone number: Email: Current employment status Full-time Part-time Completed tertiary degrees Year Degree (e.g., MSc, PhD) Current position Position title (e.g. Institution postdoctoral fellow) Institution Awards and prizes received Year Title Brief description Presentation Details Type of presentation Oral Poster Title of your oral paper/poster presentation How is this conference relevant to your research area, and why is it important that you attend (Max. 200 words) Financial Details Estimated conference attendance costs in Australian Dollars Air travel $ AU Registration $ AU Accommodation $ AU Total $ AU Please give details of financial support sought or obtained from other sources Source Amount Successful? $AU $AU $AU Y/N/Pending What is the total amount of financial support you are seeking from $AU INI2016? What is the minimum level of financial support needed from INI2016 to $AU guarantee your attendance at this conference? Check list Have you included these documents (electronic versions only) with your application? Completion of the supervisor’s box and their signature A single page CV (including any publications that you have authored) Your academic record (scanned and included in this PDF) An abstract of the oral paper or poster that you are presenting Please name two referees who could support your application Name Institution Email address Signature of applicant: Date: To be completed by the supervisor Supervisor Name: Email Address: Institute: Is this person a researcher in your organisation? Is this person presenting an oral paper or poster at the conference? Does this person have your support to attend this conference? Will this person benefit from attending this conference? Does this person have access to other funding? Any other comments from supervisor Signature of supervisor: Date: