The Clean Technology Innovation Program is a competitive, merit based grant program.
The objective of the Program is to increase applied research and development, proof of concept and early stage commercialisation activities that lead to the development of new clean technologies and associated services including low emission and energy efficient solutions that reduce greenhouse gas emissions.
The Program will help Australian industries improve their competitiveness and sustainability in the transition to a low carbon future by developing a range of clean technologies and associated services.
By supporting projects that result in increased innovative solutions for Australian industry in the transition to a carbon constrained economy, the Program will deliver benefit to Australia through
 Contributing to the objectives of the Australian Government's Clean Energy Future plan such as reducing dependence on existing pollution-intensive technologies; and
 Providing broader economic and/or social benefit to Australia and Australian industries
This form is to register your interest in the Clean Technology Innovation Program and to provide information about you and your planned project. Whilst not part of the assessment process, the form is the first step in applying for a Clean Technology Innovation Program grant and will help determine whether you are eligible to apply. An AusIndustry Customer Service Manager will be in contact with you shortly to discuss your proposed project.
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Fields marked with an asterisk (*) must be completed before the form is submitted.
If you are having difficulty filling out the form please contact the AusIndustry Hotline on 13 28 46.
Please ensure you understand the requirements of this program by carefully reading the Clean
Technology Innovation Program Customer Information Guide.
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Applicant Business Name: *
Applicant’s Australian Business Number (ABN) *
Legal/Registered Entity Name *
Date of registration of ABN (dd/mm/yyyy) *
Please indicate which type of applicant you are * ( Please refer to Section 2.1 of the Customer
Information Guide ).
Company
A wholly or majority owned Commonwealth or State Government body
Incorporated trustee applying on behalf of a trust
Contact Person Details
Title *
---- Please select ----- If ‘Other’ please specify:
Given Name(s) *
Family Name *
Position Title *
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Phone Number *
Mobile Number *
E-mail *
Postal Address *
Core Business Activities *
Please provide a brief description of the applicant entity (that is applying), any parent company structure and the applicant’s management team. *
Applicant information for most recent financial year.
*
Annual Revenue $
Profit/Loss over year $
Equity at year end
No. of employees at year end
$
Please provide details about the applicant entity’s experiences and/or history which are relevant to the proposed project. If the applicant entity is a new company, start-up or not yet created, please provide the details about yourself and/or other major participants in the proposed project. *
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What is the proposed project?
Please give a short description of what the applicant plans to develop, or achieve and how the proposed project will reduce greenhouse gas emissions or result in energy efficiency.
Please provide an estimate of the expected annual greenhouse gas emissions savings from the proposed project including in terms of the proposed product, process or service and estimated deployment over the 5years after the project ends. *
Briefly outline the innovative aspect/s of the proposed project. *
Does the applicant own or have beneficial use of the intellectual property necessary for the proposed project?
Yes
No
Please provide details of the intellectual property the applicant currently owns or has use of, or any plans to acquire, or develop IP during the proposed project ( refer to Section 2.1 of the Customer
Information Guide ).
*
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Which of these activities will the proposed project include? ( Please refer to Section 2.2 and Appendix
1 of the Customer Information Guide for definitions of these terms ).
*
Applied Research and Development
Proof of Concept
Early Stage Commercialisation
Project Address – where will the proposed project be undertaken? *
Expect project time frame (years/months) – Please note the maximum project period is 2.5 years . *
Please provide an estimate of the total project cost. *
$
Please provide an estimate of the total grant amount sought. *
$
The Clean Technology Innovation Program is a co-investment program where the applicant will be required to match grant funding dollar for dollar over the life of the proposed project.
Please identify how the applicant will match the grant amount dollar for dollar? E.g. from cash flow, loans, equity, project partner contributions, etc ( Refer to Section 2.1 of the Customer Information
Guide ) *
Cash Flow
Loans
Equity
Project partner contributions
Other
Please provide specific details regarding how the above method(s) will be used to match the grant amount dollar for dollar. *
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What will the applicant use the grant funding for (that is, what eligible expenditure will the applicant use the grant funding for), should the application be successful?
Please refer to the Eligible Expenditure Guidelines in Appendix 3 of the Customer Information
Guide for further information on activities considered eligible expenditure under the Clean
Technology Innovation Program.
Please briefly outline the market for the proposed product, process or service. Include details of any competitors. *
The completed Registration of Interest for the Clean Technology Innovation Program is to be submitted as a Microsoft Word document and sent by email to: CTINNP-ROI@innovation.gov.au
Alternatively a hard copy can be mailed to:
Clean Technology Innovation Program Management
GPO Box 9839
Canberra ACT 2601
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