2017 MRSP SPECIAL INFRASTRUCTURE SCHEME
EMCR EQUIPMENT
GRANT APPLICATION FORM
Please return completed application to [email protected]
Nominations close 5:00pm, Wednesday 7 June 2017
1. CHIEF INVESTIGATOR (C1) INFORMATION
Title
Given Name (s)
Surname
Current position
Level of Appointment (e.g. Level A.8)
Commencement date of current appointment
End date of current appointment
Appointment Full Time Equivalent
(e.g. 1.0FTE; 0.2FTE)
HMRI Research Program
Email
Telephone
Gender
Investigator Career Status
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☐ ECR
☐ MCR
[must be within 5 years
post-PhD at time of
nomination (i.e. PhD must
have been conferred after
7/06/12 – or career
interruption detail provided
below)]
Date PhD conferred
Career Interruption (if applicable)
[must be within 5 – 15 years
post-PhD at time of nomination
(i.e. PhD must have been
conferred after 7/06/02 but
before 7/06/12 – or career
interruption detail provided
below)]
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Please outline detail of career interruption(s) due to
specified career and life experiences including detail on
length of interruption(s) in months.
☐ I would like to be added to an email list to receive further information on consultation
opportunities and initiatives for HMRI-affiliated early and mid-career researchers.
2. ADDITIONAL CHIEF INVESTIGATORS
PLEASE COPY AND PASTE THE BELOW TABLE TO INCLUDE ADDITIONAL CHIEF INVESTIGATORS
Title
Given Name (s)
Surname
Current position
HMRI Research Program
Email
Telephone
Gender
Investigator Career Status
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☐ ECR
☐ MCR
[must be within 5 years
post-PhD at time of
nomination (i.e. PhD must
have been conferred after
7/06/12 – or career
interruption detail provided
below)]
Date PhD conferred
Career Interruption (if applicable)
[must be within 5 – 15 years
post-PhD at time of nomination
(i.e. PhD must have been
conferred after 7/06/02 but
before 7/06/12 – or career
interruption detail provided
below)]
Click or tap here to enter text.
Click or tap here to enter text.
Please outline detail of career interruption(s) due to
specified career and life experiences including detail
on length of interruption(s) in months.
☐ I would like to be added to an email list to receive further information on consultation
opportunities and initiatives for HMRI-affiliated early and mid-career researchers.
Note:
A two (2) page Track Record Statement must be attached for every Chief Investigator listed in this
application
3. EQUIPMENT DETAILS
SUMMARY OF EQUIPMENT
Please provide a brief high-level lay summary of the proposed minor equipment or general infrastructure
(500 words)
This should address:


Itemised details of the general infrastructure and/or minor equipment (including name and make
of equipment) and broad research use
The proposed location of the minor equipment and general within the HMRI Building or other
location (include Building, Level and Specific Room)
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PROPOSED MANAGEMENT PLAN
If applicable, please outline the management and maintenance requirements for any minor equipment
requested in this application. Include details of the estimated annual maintenance and repairs costs and
propose how these costs will be managed. Please outline if this is not applicable. (500 words)
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4. ASSESSMENT CRITERIA
Provide a summary of the EMCR research team listed on the application and a description of how this funding will help build research capacity and support
current and future research projects. Preference will be given to applications that support teams led by EMCRs, or contribute to EMCR collaborations across
HMRI Research Programs, UON PRCs, Hunter New England Local Health District, and/or with industry and end-users.
Note:
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Two (2) page Tack Record Statement for all listed Chief Investigators must also be attached to the application
EMCR Name
HMRI Program
CI1
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CI2
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CI3
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CI4
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CI5
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CI6
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UON PRC
(if applicable)
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Description of how this funding will help build research capacity and support
current and future research projects
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Please outline how the minor equipment or general infrastructure will assist to leverage other external
funding (for example, NHMRC Project Grant funding) (500 words)
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If applicable, outline how you have ensured that the requested equipment can be accommodated in the
existing floor space of the location proposed, including any changes to, requirement for, or interfacing with
existing building services infrastructure and how these costs will be managed (where in doubt the
specifications should be discussed with the HMRI Facilities Manager, or equivalent representative for
alternative sites); and how the maintenance and repairs for any minor equipment requested in this
application will be funded. (300 words)
Note:
Detail is only required if requesting funds for a large item of equipment.
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5. EQUIPMENT BUDGET
EQUIPMENT BUDGET TABLE
Please provide a detailed budget (GST exclusive), itemising the costs of all minor equipment and general
infrastructure being request - including any shipping, installation and maintenance costs, if applicable.
Note:
 A maximum of $10,000 can be requested
 Funds cannot be used to co-fund larger items of equipment unless HMRI purchases and owns the equipment.
MINOR EQUIPMENT OR GENERAL INFRASTRUCTURE DESCRIPTION
$
1.
$
2.
$
3.
$
4.
$
5.
$
(A) EQUIPMENT COSTS SUB-TOTAL $
OTHER FUNDING CONTRIBUTIONS TOWARDS EQUIPMENT (IF APPLICABLE)
Please detail source 1 (e.g. Industry/External)
$
Please detail source 2 (e.g. UoN-other/Industry/External)
$
(B) OTHER FUNDING CONTRIBUTIONS SUB-TOTAL $
TOTAL AMOUNT REQUESTED FROM THIS GRANT (A – B) $
Note:
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Quote(s) and evidence of other funding contributions must be attached to this application.
BUDGET JUSTICATION
Please provide a justification of all budget items for which you are requesting HMRI EMCR Equipment Grant
funding. Items must be justified under the budget line descriptions used in the above table (500 words)
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CHIEF INVESTIGATOR (CI1) CERTIFICATION
As Chief Investigator, I confirm the following:


I certify that all information included in this application is true and correct.
I confirm that I am not listed on any other HMRI EMCR Equipment Grant application
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------------------------Date
ADDITIONAL CHIEF INVESTIGATOR (CI2) CERTIFICATION
As Chief Investigator, I confirm the following:


I have agreed to be included on this proposal and have reviewed the application.
I am not listed on any other HMRI EMCR Equipment Grant application
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------------------------Date
PLEASE COPY AND PASTE TABLE TO INCLUDE ALL SIGNATURES FOR ALL ADDITIONAL CHIEF
INVESTIGATORS
HMRI PROGRAM LEADER CERTIFICATION
As HMRI Program Leader of Chief Investigator (CI1), I confirm the following:

I certify that I have reviewed the application and support the minor equipment and/or general
infrastructure items requested.
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------------------------Date
APPLICATION CHECKLIST
As Chief Investigator, I confirm the following:
☐ All sections of the Application Form are complete
☐ All listed Chief Investigators have Certified this application
☐ The head of my HMRI Research Program has reviewed and certified the Application Form
☐ I have attached: Two (2) page Track Record Statements for all Investigators listed on application
☐ I have attached: Quote(s) for all equipment/infrastructure costs detailed in the ‘Equipment Budget
Table’
☐ I have attached: Evidence of other funding support outlined ‘Equipment Budget Table’ (if
applicable)
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