ACEM Foundation International Development Grant

ACEM Foundation International Development Grant
Form No: AP392
Last Revised: November 2024

Applications for the grant must be received no later than 5pm AEDT Monday 31 March 2025

For further information, eligibility criteria and terms and conditions, see the College
ACEM Foundation Grants Policy.

If you require assistance to complete this form, please contact: gecnetwork@acem.org.au

Related documents:

1. Applicant Details
1.1 List partner country or countries*
Preference will be given to projects focusing on developing countries as defined in the ACEM Policy on Defining ‘Developing Country’ (COR446).
1.2 Details of the applicant organisation and contact person
Organisation*
Postal address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact person*

First NameLast Name
Contact person position*
Telephone*
Fax
Email*
example@example.com
1.2.1. Has the organisation and/or applicant/s perviously been recipients of an IDG?*

YesNo
Previous project name*
Year received the IDG*
Verified project completion date*

DayMonthYear
Date
Was the submitted ‘Project Completion Report’ evaluated?*

YesNo
1.3 Title of project*
1.4 Expected start and finish dates of the project
Project start date*

DayMonthYear
Date
Project finish date*

DayMonthYear
Date
1.5 Total amount of funding you are applying for*

2. Responses to selection criteria
2.1 Describe the context for the project and identified needs. (maximum 500 words)*
2.2 What is/are the detailed aims/s of the project (max 300 words plus table)? These project aims and objectives can be represented in a framework as recommended in section 2.7*
2.3 Describe how the project promotes the development of emergency care in the country/region the project is based? (max 200 words)*
2.4 What activities will the project entail (max 500 words)*
2.5 What outcomes are expected to occur as a result of the project and its intended impact, including the reach of the outcomes in terms of development of emergency care in the country/region the project is based? (max 200 words)*
2.6 How will the outcomes of the project be sustained? (max 200 words)*
2.7 How will the project be evaluated? Please provide an outline of the monitoring and evaluationframework to be used for the project (max 200 words plus table).*
2.8 Describe the current linkages that exist between you (your group, other FACEMs, ACEM, other stakeholders) and the partner organisation / country demonstrated to the aims of the project. In addition, indicate the level of local support and if it is a locally driven initiative. (Please attach a letter of support for application from the partner organisation as well as other evidence (if required) indicating that it is locally supported and is a locally driven initiative) (max 200 words).*
2.9 Outline the alignment of the project with other ACEM GEC projects and/or ACEM partnerships in this country and/or region (if any) and how it will and how it will interact with these projects and partners? Please indicate if consultation has been sought from the ACEM GEC Country Liaison Representative (CLR) and/or Regional Liaison Representative for the relevant country (Contact gecnetwork@acem.org.au for CLR details and current ACEM GEC initiatives) (max 200 words).*
2.10 Project Funding

Related document: Budget propsal form
2.10.1. Outline the budget for the project (AUD), outlining the expected source of funding (IDF and/or non-IDF) for each item. *
It is strongly recommended that applicants include quotes for all significant items. Should airfare, accommodation and any specific equipment purchases be included in the grant application, provision of quotes (internet screenshots will be accepted) must be attached to the application form. Purchases must be itemised and justified with the source of quotes for these items provided. (refer to budget proposal form describing how the costs were determined and include quotes where possible). Note if project requires stationary, general procurement items and printing, these are to be locally sourced and driven. Specify requirement and request reasons why if requirement not met.
2.10.2. What other sources of funding are potentially available? (max 100 words)*
2.10.3. Where else have you applied for funding/what was the outcome? (max 100 words)*
2.10.4. Provide an overall breakdown of the funding arrangement, including requested project budget, other funders input, local input, and in-kind by applicant/s. (max 100 words plus completed budget proposal form).*
Please upload your completed Budget Proposal Form*

Cancelof
2.10.5. Provide a paragraph justifying the use of an IDF Grant for items listed in the budget, with particular attention to the cost-effectiveness or ‘value for money’ of the project. Specific details regarding the type of equipment required should be listed, including outline of sustainability of the equipment in terms of ongoing costs of equipment maintenance and storage requirements (max 100 words).*

3. Use of resources
It is strongly recommended that any new teaching materials developed as a result of an IDG are made open access, so that those working to establish emergency medicine systems internationally have access to as many resources as possible.
Do you allow/approve ACEM to make your resources available to the public.*

YesNo
If you believe that ACEM should not be allowed to publicly share resources developed as part of your IDG proposal, please provide further details as to why this should be the case.*

4. Details and signature of applicant
Signature*

Clear
Date*

DayMonthYear
Date

ACEM Foundation International Development Grant

5. Declaration