ALBERTA AGRICULTURAL RESEARCH INSTITUTE (AARI)
Value Added Technology Transfer Program
Application Form

Office Use Only:	Date Received					Application Number

1.	Project Title (maximum 15 words)

2.	Commencement and Duration of Project
Expected commencement date for this request: 		
Anticipated duration of project is		month(s)	

3.	Project Manager
Name			Mailing Address		
Title					
Organization					
Department			Telephone #		
			Fax #		

4.	Co-applicant
Name			Mailing Address		
Title					
Organization					
Department			Telephone #		
			Fax #		

	Co-applicant
Name			Mailing Address		
Title					
Organization					
Department			Telephone #		
			Fax #		

5.	Approval of Employer(s)

This application is submitted, and will be evaluated, under the authority of the Alberta Agricultural Research Institute Act and the Value Added Technology Transfer Program Guidelines.  As representatives of the applicants’ employing organization, the undersigned hereby verify acceptance of the terms and conditions specified in the guidelines.  They further agree to allow the applicant to devote time to the project and use the facilities of the organization to conduct the proposed project.  Please print or type name on the first line and sign in blue ink (see block 5 instructions for required signatures).
Project Manager’s Organization	
A. Name			Title		
Signature			Date		
B. Name			Title		
Signature			Date		
C. Name			Title		
Signature			Date		
Co-applicant’s Organization	
Co-applicant’s Name			
A. Name			Title		
Signature			Date		
B. Name			Title		
Signature			Date		
C. Name			Title		
Signature			Date		
Co-applicant’s Organization	
Co-applicant’s Name			
A. Name			Title		
Signature			Date		
B. Name			Title		
Signature			Date		
C. Name			Title		
Signature			Date		

6.	Outline of Project Proposal (one page may be added to this block if required)
	A.	Background Description of the Technology, Knowledge, Product or Process Improvements to be transferred and Expected Results 

		i.	Project Description

		ii.	Key Results Expected

	B.	Expected Industry Impact/Benefits of the Project

C.	Project Plan

	C.	Project Plan (continued)

D.	Action Plan Stating When Key Actions Will be Taken and Expected Results Achieved

	

	E.	Related Project Conducted in Your Organization

	F.	Related Projects Carried out in Other Agencies

	G.	List 2 References

7.	Budget and Manpower Needs
State the amount being requested in each category.  One page may be added to this block to describe budget requests or any unusual items.

	A.	Manpower

Name		

Title		Person Years Required 		Salary/Wage Amount Requested	

Project Manager	

		
	
Co-applicant (1)								
Co-applicant (2)								
Professional								
								
Technical								
								
Graduate Students								
								
Other (specify)								
			TOTAL A		$		$	

Note:	Project managers and co-applicants who are employees of public institutions are not eligible for wages,  honoraria, or other compensation from project funds.  However, they must note the amount of time they expect to devote to the project during the fiscal year.  Applicants should carefully read the instructions before completing block 7.

	B.	Equipment Rental

TOTAL B		
$	

	C.	Supplies and Services
		i.	Travel (includes travel and accommodation costs)
			a.	Project Travel
Traveller’s Name					
Destination(s)					
Number of Trips					
Mode of Travel					
Purpose					
					
			Cost	$	

		ii.	Materials/Supplies (if you have more than six items, please attach a list)  
List Item		Quantity		$ Per Unit		Cost	

							

							
		
		iii.	Computer Cost

			
TOTAL C		$	
	
	D.	Overhead Cost

			
TOTAL D		$	

		Indicate how overhead costs were calculated (refer to instructions on page 5):

TOTAL PROJECT BUDGET		$	

8.	 Summary of Budgets for Anticipated Duration of Project

	A.	Enter the total amount being requested.
Category	Amount	
Manpower		
Equipment Rental		
Travel		
Materials/Supplies		
Computer Cost		
Overhead Cost		
TOTAL	$	

B.	State the expected duration of the project in months:		

9.	Matching Support Applied for, Granted, or Promised for This Project From Sources Other Than Alberta Government Departments, Agencies or Programs

Funding Agency		
Amount of Grant in Cash		
Amount of Grant In-kind		Total Amount Applied for, Granted or Promised		
Date Grant Received or Expected	
A.										
B.										
C.										
D.										

TOTAL AMOUNT REQUESTED FROM OTHER AGENCIES (A + B + C + D)	
$	

10.	Amount Requested From AARI

	Total amount requested from AARI  for the duration of the project $___________.  (The amount requested from AARI should not exceed either 50% of the project budget or $25,000, whichever is less.)

11.	Terms and Conditions

	A.	This application is submitted, and will be evaluated under the authority of the Alberta Agricultural Research Institute Act and the Value Added Technology Transfer Program Guidelines.  The applicant accepts the conditions specified in the guidelines.
	B.	All completed applications submitted to AARI become the property of AARI and will not be returned to the applicant.  While every effort will be made to keep the information contained in the application form confidential, the application review procedures require that copies of the application be distributed to a number of reviewers.  The contents of this application may also be subject to access under the Freedom of Information and Protection of Privacy Act.  By signing below, the proponent authorizes AARI to release the information contained in the application at its discretion.

	C.	AARI’s decision regarding this application is final.

			
	Project Manager’s Signature					Date

	Co-applicant’s Signature						Date

	Co-applicant’s Signature						Date

PROJECT MANAGER - BIOGRAPHICAL DATA

Name (surname first):

Post-Secondary Education and Training Relevant to Proposal:

Institution	Field of Specialization	Degree/Diploma	Year Completed	

Relevant Professional Experience (begin with present position):

Dates	Position or Function	Employer	Location

Activities Performed by the Project Manager That Relate to the Proposed Project (List up to 4).

Title	Date

CO-APPLICANT (1) - BIOGRAPHICAL DATA
Name (surname first):

Post-Secondary Education and Training Relevant to Proposal:

Institution	Field of Specialization	Degree/Diploma	Year Completed

Relevant Professional Experience (begin with present position):

Dates	Position or Function	Employer	Location

Activities performed by the Co-applicant That Relate to the Proposed Project (list up to 4).

Title	Date

CO-APPLICANT (2) - BIOGRAPHICAL DATA

Name (surname first):

Post-Secondary Education and Training Relevant to Proposal:

Institution	Field of Specialization	Degree/Diploma	Year Completed

Relevant Professional Experience (begin with present position):

Dates	Position or Function	Employer	Location

Activities Performed by the Co-Applicant That Relate to the Proposed Project (list up to 4 projects):

Title	Date

ACKNOWLEDGEMENT OF RECEIPT

Please fill out the name, address and title information and submit this form with your original application (14 copies of this sheet are not required).  The form will be returned to you to acknowledge receipt of your Value Added Technology Transfer Program application by the Alberta Agricultural Research Institute.

Principal Researcher		
Mailing Address		

		

This is to acknowledge receipt of your proposal entitled:

	

For Office Use Only

Your proposal has been assigned project number _______________________.  Please quote this number on future correspondence.

Your application is:

__________complete as received
__________incomplete.  Please forward immediately:

__________14 photocopies of your application
	__________original signatures in Blocks 5 & 11 for:
				_______________________________________________________
				_______________________________________________________
				__________animal care certificate
	__________completed biographical data for:
				_______________________________________________________
__________       __________________________________________

Date Received:    ________________________________________