PO Box 241, St Leonards, NSW 1590 (Incorporated in the ACT)
GRANT ROUND 2017
GRANT APPN …………..…..
FOUNDATION USE ONLY
GRANT ROUND
APPLICATION FOR RESEARCH GRANT
Closing date for Submission 31 March
Applications are to be converted to pdf and uploaded to the grants upload link on the ADRF
webpage http://www.ada.org.au/ADRF*
Only this version of the application form will be accepted. Any omissions will deem the
Application non-compliant.
1A
PROJECT TITLE
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
1B
NEW PROJECT
1C
KEYWORDS

OR
 ADRF-FUNDED
CONTINUATION OF PROJECT
 NON-ADRF-FUNDED
(List up to five keywords)
……………………………………………………………………………………………………………………
2A
PRIMARY APPLICANT
………………………………
……………………………………….
……… ……………………………
SURNAME
GIVEN NAMES
TITLE
QUALIFICATIONS
………………………………………
……………………………………. …………………………………
APPOINTMENT/PRACTICE TYPE
INSTITUTION (If applicable)
………………………………………
……………………………………. .……………………………......
CONTACT ADDRESS (STREET)
CITY
DEPARTMENT (If applicable)
STATE AND POSTCODE
………………….
………………..
…………………...
……………………………………
PHONE (WORK)
FAX (WORK)
PHONE (HOME)
EMAIL
PLEASE INDICATE IF THIS APPLICANT IS IN ONE OF THE FOLLOWING CATEGORIES:
PRIVATE PRACTITIONER ,
EARLY CAREER RESEARCHER ,
SENIOR RESEARCHER 
POSTGRADUATE STUDENT ,
HONOURS STUDENT ,
UNDERGRADUATE STUDENT 
IF THE APPLICANT IS A STUDENT, WHO IS THEIR RESEARCH SUPERVISOR ……………………………………………
IS ADMINISTRATION OF THE GRANT AND CORRESPONDENCE THE RESPONSIBILITY OF THIS APPLICANT?
YES / NO
1
2B
ASSOCIATE APPLICANT
………………………………
……………………………………….
……… ………………………
SURNAME
GIVEN NAMES
TITLE
QUALIFICATIONS
………………………………………
…………………………………
………………………………
APPOINTMENT/PRACTICE TYPE
INSTITUTION (If applicable)
DEPARTMENT (If applicable)
………………………………………
…………………………………….
………………………......
CONTACT ADDRESS (STREET)
CITY
STATE AND POSTCODE
………………….…
………………..…
…………………...…
……………………………………
PHONE (WORK)
FAX (WORK)
PHONE (HOME)
EMAIL
PLEASE INDICATE IF THIS APPLICANT IS IN ONE OF THE FOLLOWING CATEGORIES:
PRIVATE PRACTITIONER ,
EARLY CAREER RESEARCHER ,
SENIOR RESEARCHER 
POSTGRADUATE STUDENT ,
HONOURS STUDENT ,
UNDERGRADUATE STUDENT 
IF THE APPLICANT IS A STUDENT, WHO IS THEIR RESEARCH SUPERVISOR? …………………………………………
IS ADMINISTRATION OF THE GRANT AND CORRESPONDENCE THE RESPONSIBILITY OF THIS APPLICANT?
YES / NO
2C
ASSOCIATE APPLICANT
………………………………
……………………………………….
…….. .……………………………
SURNAME
GIVEN NAMES
TITLE QUALIFICATIONS
………………………………………
……………………………………. ………………………………
APPOINTMENT/PRACTICE TYPE
INSTITUTION (If applicable)
………………………………………
…………………………………….
CONTACT ADDRESS (STREET)
CITY
………………….
………………..
PHONE (WORK)
FAX (WORK)
DEPARTMENT (If applicable)
.…………………………
STATE AND POSTCODE
…………………...
PHONE (HOME)
……………………………………
EMAIL
PLEASE INDICATE IF THIS APPLICANT IS IN ONE OF THE FOLLOWING CATEGORIES:
PRIVATE PRACTITIONER ,
EARLY CAREER RESEARCHER ,
SENIOR RESEARCHER 
POSTGRADUATE STUDENT ,
HONOURS STUDENT ,
UNDERGRADUATE STUDENT 
IF THE APPLICANT IS A STUDENT, WHO IS THEIR RESEARCH SUPERVISOR? …………………………………………
IS ADMINISTRATION OF THE GRANT AND CORRESPONDENCE THE RESPONSIBILITY OF THIS APPLICANT?
YES / NO
2
2D
ASSOCIATE APPLICANT
………………………………
……………………………………….
…….. ……………………………
SURNAME
GIVEN NAMES
TITLE QUALIFICATIONS
………………………………………
…………………………………….
……………………………
APPOINTMENT/PRACTICE TYPE
INSTITUTION (If applicable)
DEPARTMENT (If applicable)
………………………………………
…………………………………….
CONTACT ADDRESS (STREET)
CITY
.…………………………
STATE AND POSTCODE
………………….
………………..
…………………...
……………………………………
PHONE (WORK)
FAX (WORK)
PHONE (HOME)
EMAIL
PLEASE INDICATE IF THIS APPLICANT IS IN ONE OF THE FOLLOWING CATEGORIES:
PRIVATE PRACTITIONER ,
EARLY CAREER RESEARCHER ,
SENIOR RESEARCHER 
POSTGRADUATE STUDENT ,
HONOURS STUDENT ,
UNDERGRADUATE STUDENT 
IF THE APPLICANT IS A STUDENT, WHO IS THEIR RESEARCH SUPERVISOR? ……………………………………………
IS ADMINISTRATION OF THE GRANT AND CORRESPONDENCE THE RESPONSIBILITY OF THIS APPLICANT?
YES / NO
3
3
BRIEF CURRICULUM VITAE
A
PRIMARY APPLICANT
B
ASSOCIATE APPLICANT
C
ASSOCIATE APPLICANT
D
ASSOCIATE APPLICANT
4
4. WHERE IS THE WORK TO BE UNDERTAKEN?
5. HOW MANY HOURS PER WEEK WILL THE APPLICANT/S DEVOTE TO THE PROJECT?
A.
PRIMARY APPLICANT
……………………………
HOURS
B.
ASSOCIATE
……………………………
HOURS
C.
ASSOCIATE
……………………………
HOURS
D.
ASSOCIATE
……………………………
HOURS
6.
WHAT TECHNICAL/OTHER STAFF WILL BE AVAILABLE TO ASSIST THE PROJECT?
7.
DURATION OF PROJECT
COMMENCEMENT DATE
………………………………………..
ANTICIPATED COMPLETION DATE ………………………………………...
8.
Note: For projects
designed to be
managed in stages
over more than one
year, it is necessary
to submit a new
application each
year
RESEARCH GRANTS HELD BY APPLICANT/S IN LAST FIVE YEARS (All Projects)
Grantee
Source of Funds
Project Title
Amount
Years
5
9.
RESEARCH GRANTS CURRENTLY HELD BY APPLICANT/S (All Projects)
Grantee
10.
Source of Funds
Project Title
Amount
Years
RESEARCH GRANTS UNDER CONSIDERATION (All Projects)
Applicant/s
Funding Body
Project Title
Amount Requested
Date Outcome Known
6
11.
BUDGET (For One Year)
Mark with an “A” those costs that are absolutely essential
for the project to proceed
$
CONTRACT SERVICES
PLEASE NOTE FULL OR PARTIAL SALARIES FOR STAFF WILL NOT BE
FUNDED. PLEASE LIST MATERIALS, CONSUMABLE SUPPLIES,
APPARATUS, ANIMALS AND MINOR EQUIPMENT [UP TO $1,000] PROVIDED
THAT ANY FUNDING PROVIDED IS NOT WHOLLY OR MAINLY USED FOR
INFRASTRUCTURE PURPOSES AS DESCRIBED IN CRITERIA 1 AND 7 OF
THE AUSTRALIAN COMPETITIVE GRANTS FUNDING SCHEME QUALIFYING
CRITERIA.
Data Processing
Engineering
Other
EQUIPMENT AND APPARATUS
CONSUMABLE SUPPLIES
TRAVEL
(Will be funded only where necessary to carry out the project)
OTHER
TOTAL
NB:
GRAND TOTAL
Figures MUST AGREE with item 12 on Page 8
7
12.
EXPLANATORY NOTES ON BUDGET
Show clearly under appropriate headings how the requested
amounts were calculated. This must, for example, include an
estimate of how many consumable supplies are needed and the
cost per item.
$
8
13. WHAT ARE THE AIMS OF THE PROJECT?
[Type a quote from the document or the summary of an interesting point. You can position the text
box anywhere in the document. Use the Drawing Tools tab to change the formatting of the pull
quote text box.]
14. WHY DO YOU CONSIDER THEM IMPORTANT AND WHAT IS THEIR DENTAL RELEVANCE?
9
15. DETAILED DESCRIPTION OF THE PROJECT
(INCLUDING RESUME OF EXISTING KNOWLEDGE IN THE RELEVANT FIELD)
Provide a description of the materials and methods to be used and, if appropriate, the statistical
procedures – your description should not exceed five (5) A4 pages. Where human or animal
subjects or biological specimens are used with the project, a Certificate of Ethical Clearance
from the appropriate authority is mandatory (see Item 19)
10
15. DETAILED DESCRIPTION OF THE PROJECT (Continued)
11
15. DETAILED DESCRIPTION OF THE PROJECT (Continued)
12
15. DETAILED DESCRIPTION OF THE PROJECT (Continued)
13
15. DETAILED DESCRIPTON OF THE PROJECT (Continued)
14
16. REFERENCES RELEVANT TO ITEM 15 ABOVE
15
17.
LIST OF PUBLISHED WORK AND REPORTS BY APPLICANT/S IN THE LAST FIVE (5)
YEARS ONLY
(Please append the list if the space provided here is insufficient. Abstracts and
proceedings should NOT be listed.)
18.
OTHER RESEARCH PROGRAMMES BEING UNDERTAKEN OR SUPERVISED BY THE
APPLICANT/S
19.
A CERTIFICATE OF ETHICAL CLEARANCE
(1)
Is Appended

(2)
Will follow this application

(3)
Is Unnecessary

16
20.
DETAILS OF POTENTIAL GRANT REVIEWERS
PLEASE PROVIDE THE NAMES AND CONTACT DETAILS OF TWO (2) POTENTIAL REVIEWERS WHO CAN
PROVIDE FEEDBACK ON THIS GRANT PROPOSAL. REVIEWERS MUST NOT BE FROM THE SAME INSTITUTION
OR STATE. THE ADRF RESEARCH ADVISORY COMMITTEE MAKES FINAL RECOMMENDATIONS ON THE
SELECTION OF REVIEWERS.
REVIEWER 1
………………………………
……………………………………….
…….. ……………………………
SURNAME
GIVEN NAMES
TITLE QUALIFICATIONS
………………………………………
…………………………………….
…………………………
APPOINTMENT/PRACTICE TYPE
INSTITUTION (If applicable)
DEPARTMENT (If applicable)
………………………………………
…………………………………….
.……………………………
CONTACT ADDRESS (STREET)
CITY
STATE AND POSTCODE
………………….
PHONE (WORK)
………………..
FAX (WORK)
…………………...
…...……………………...…………
PHONE (HOME)
EMAIL
REVIEWER 2
………………………………
……………………………………….
…….. ……………………………
SURNAME
GIVEN NAMES
TITLE QUALIFICATIONS
………………………………………
…………………………………….
……………………………
APPOINTMENT/PRACTICE TYPE
INSTITUTION (If applicable)
DEPARTMENT (If applicable)
………………………………………
…………………………………….
.…………………………
CONTACT ADDRESS (STREET)
CITY
STATE AND POSTCODE
………………….
………………..…..
………………...…..
………………………………......
PHONE (WORK)
FAX (WORK)
PHONE (HOME)
EMAIL
21.
(a)
(b)
(c)
SIGNATURE OF APPLICANT/S:
The applicants by the execution of this Application Form shall
acknowledge and accept the absolute discretion of the Directors of the AUSTRALIAN
DENTAL RESEARCH FOUNDATION INC to decide in any year which projects will receive
Grants from the Foundation and the size of those Grants and their absolute discretion to us
whatever means, methods and criteria they consider appropriate to make such decisions,
and
agree that an applicant does not now or in the future have a right to challenge such
decisions of the Directors of the Foundation, and
agree to review grants for the AUSTRALIAN DENTAL RESEARCH FOUNDATION INC in
the spirit of collegiality, and will have their grant/s denied if they do not participate in the
grant review process.
SIGNATURES
DATE
……………………………..
……………………………..
……………………………..
……………………………..
……………………………..
17
22.
CERTIFICATE OF HEAD OF DEPARTMENT WHERE APPLICANT IS TO WORK IN AN
INSTITUTION OR UNIVERSITY DEPARTMENT (NOT REQUIRED FOR RESEARCH
UNDERTAKEN IN A PRIVATE PRACTICE).
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 have
noted the contents of Item 19 regarding Ethics Approval.
SIGNATURE …………………………………………………………………………
NAME ……..………………………………… DATE …………………………….
*Applicants are requested to complete the MS Word Version of the application form by typing directly into each field. Applicants should
save a copy for their records and upload all of the completed form by following the links to the grants upload webpage on
http://www.ada.org.au/ADRF. It is recommended that applicants convert the completed Word document to a PDF file prior to
submission to minimise the risk of file or format changes. Scanned or electronic signatures should be included with the application.
Last updated September 2016
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