ANZAOMS Research & Education Foundation and Trust

ANZAOMS Research & Education Foundation and Trust

Research Grant Application Form
Application for a Research Grant

Please complete this form to apply for a research grant. Please ensure that all relevant supporting documentation is attached. The form contains an automated process for obtaining approval from third parties, where required. It is your responsibility to advise the relevant individuals that they will be required to respond before the application is considered by the Research & Education Management Committee.
Section I: Details of Applicant/s
1. Full Name of Applicant/s
Primary Researcher*

PrefixFirst NameLast Name
Primary Researcher Email*
example@example.com
Others

PrefixFirst NameLast Name
Others

PrefixFirst NameLast Name
2. Title of Research Project*
3. Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone (Work)*
Telephone (Mobile)*
4. Primary Researcher - Present Appointment and Institution (where applicable)*
5. Primary Researcher - Academic Qualifications*
6. Primary Researcher - Brief Biographical Details*
Details of Recipient Institution

All grant funds must be managed by an approved Institution. The institution must be a registered Charity with the ACNC and must have Item 1 Deductible Gift Recipient Status (DGR). These details can be accessed via ABN Look Up www.abr.business.gov.au
Recipient Instiution Name*
The institution who will be managing the grant funds
Recipient Institution ABN*
Does this institution have ACNC Registered Charity Status?

YesNo
Does this institution have DGR Item 1 Status?

YesNo
Section II: Details of the Project
7 a. What are the Aims of the Project?*

0/500
7 b. Detailed Description of the Project*

A description of the materials and methods to be used and, if appropriate, statistical procedures. Where human or animal subjects or bological specimans therefrom are used within the project, a certificate of eithical clearance from the appropriate authority is mandatory. (See Section 23)0/1000
8. Where is the work to be undertaken?*

0/500
9. How many hours per week will the Primary Applicant (s) devote to the project?*

0/500
10. Associated Investigators

Give names, appointments, academic qualification and number of hours per week to be devoted to the project.0/500
11. What Technical and Other Staff will be available to assist the Project?

0/500
Date of Commencement of Project*

MonthDayYear
Date
Expected Date of Completion of Project*

MonthDayYear
Date
Section III: Funding

13 a. Funds Previously Granted for this Project?

	$	Year
ANZAOMS R&E
Other

Other Organisations Applied to for Grants?

14. Budget and Justification

	1st Year $	2nd Year $	3rd Year $
Salaries
- Assistant Investigator
- Technical Assistance
- Secretarial Assistance
- Other (Please specify)
Contract Services
- Data Processing
- Engineering
- Other
Equipment and Apparatus
- Major (>$1000)
- Minor <$1000)
Consumable Supplies
Travel (will be funded only where necessary to carry out the project)
TOTAL
GRAND TOTAL

Grant request amount*
Budget Justification*

0/500
15. Explanatory Notes to Budget

0/1000
16. Other Research Programs being undertaken or supervised by the applicant (s)?

0/500
17. Referees

Names and Institutions of two (2) referees
Referee 1*

PrefixFirst NameLast NameInstitution
Referee 2*

PrefixFirst NameLast NameInstitution
18. Certification by Head of Department where Applicant is to work in an Institution or University Department

I certify that the project is appropriate to the general facilities in my Department/Institution and I am prepared to have the project carried out in that Department/Institution. I understand that the applicant has received approval of the Research Ethics Committee (if applicable).
Head of Department Name

PrefixFirst NameLast Name
Head of Department Email
example@example.com
Institution to receive grant funds
Automated Approval Process

Once this application is submitted, an automated email link will be sent to the Head of Department email address listed above, providing them with a copy of the full application and giving them the opportunity to 'Approve' or 'Deny' this request.
19. Resume of Existing Knowledge in the Field of Research

(Include a short bibliography)
(Please attach documentation at the end of the application form if additional space is required)*

0/2000
20. List of Published Work and Reports by Applicant/s
List of Published work and reports by Applicant/s

0/1500
21. Certificate of Ethical Clearance
Certificate of ethical clearance is;*
22. Execution by Applicant/s

The Applicant/s by their execution of this application form acknowledge and accept the absolute discretion of the Directors of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons Research and Education Foundation Trustees, to decide in any year which projects will receive grants from the fund and the amount of those grants and their absolute discretion to make such decisions and they agree that they will not have a no right to challenge such decisions of the Directors of the Fund.
Signature of Primary Applicant

First NameLast Name
Signature*

Clear
Date

MonthDayYear
Date
Researcher #2 (if applicable)

PrefixFirst NameLast Name
Researcher #2 - Email (an email will automatically be sent requesting this individual to acknowledge their support for the project).
example@example.com
Researcher #3 (if applicable)

PrefixFirst NameLast Name
Researcher #3 - Email (an email will automatically be sent requesting this individual to acknowledge their support for the project).
example@example.com
23. Attachments

Please attach all supporting documentation here.
Browse Files

Cancelof
Submission date*

MonthDayYear
Date
Should be Empty:

Application for a Research Grant

Section I: Details of Applicant/s

1. Full Name of Applicant/s

Details of Recipient Institution

Section II: Details of the Project

Section III: Funding

17. Referees

18. Certification by Head of Department where Applicant is to work in an Institution or University Department

19. Resume of Existing Knowledge in the Field of Research

20. List of Published Work and Reports by Applicant/s

21. Certificate of Ethical Clearance

22. Execution by Applicant/s

23. Attachments