International Conference Travel Grant (ICTG)
Academic Staff Application Form
(June 2013)
Application
Date:
Applicant Information of Applicant
Click here to enter a date.
Academic level?
Name:
Choose an item.
Are you an Early Career Researcher? Choose an item.
Are you transitioning to enable research activity?
Choose an item.
School/
Centre/
Institute:
Choose an item.
item.
Faculty
Choose an item.
Date PhD conferred? Click here to enter a date.
Campus
Choose an item.
Continuing/Fixed term position?
Have you experienced career disruptions Choose an
(attach details)
Choose an item.
Phone
Fixed term end date? Click here to enter a date.
ACU Email
FTE %?
Have you previously been awarded an ACU International Conference Travel
Grant?
When
2. Conference Details (attach conference flyer)
Name
Destination:
Dates of conference?
Provide a statement to
the “International
Standing” of the
conference.
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Privacy statement. Australian Catholic University is committed to ensuring the privacy of all information it collects. Personal information
supplied to the University will only be used for administrative and educational purposes of the institution. Personal information collected by the
University will only be disclosed to third parties with the written consent of the person concerned, unless otherwise prescribed by law. For
further information, please refer to the University’s Statement on Privacy http://www.acu.edu.au/more_information/privacy/.
3. Reason for Travel/Attending the Conference (attach letter(s) /emails of acceptance)
My reason for attending the conference is to:
be Keynote speaker
chair/lead a major session
present a lecture/seminar
present paper
present poster
other - please explain
4. Provide a Detailed Travel Itinerary
Date
Location
Activity
Click here to
enter a date.
Click here to
enter a date.
Click here to
enter a date.
Click here to
enter a date.
5. Research Trajectory
In the space below, explain how this conference will:
a) assist you in developing your research profile, and
b) lead to a high quality research outcomes (excludes conference publications);
(Provide details of the journal/publisher)
2|P a g e
Privacy statement. Australian Catholic University is committed to ensuring the privacy of all information it collects. Personal information
supplied to the University will only be used for administrative and educational purposes of the institution. Personal information collected by the
University will only be disclosed to third parties with the written consent of the person concerned, unless otherwise prescribed by law. For
further information, please refer to the University’s Statement on Privacy http://www.acu.edu.au/more_information/privacy/.
6. Budget To Attend The Conference
Registration fee:
Travel costs:
Accommodation:
Other:
Total of your budget:
$
$
$
$
$
Financial support from other sources?
______________
Additional amount applied for?
Additional amount received?
Will you be funded by your Faculty?
$
$
Amount you request for this conference travel?
(up to a maximum of $3000 annually)
Choose an item.
$
7. Publication Profile: Comment on your publication profile and grants over the last four years
with reference to your stage of career (maximum 250 words)
Peer review disciplines: Use national, international, or discipline-based rakings to indicate the quality of your
publications
Citation disciplines: Indicate proportion of publications in Q1, Q2, Q3, or Q4 journals. (see Scopus or Web of
Science).
3|P a g e
Privacy statement. Australian Catholic University is committed to ensuring the privacy of all information it collects. Personal information
supplied to the University will only be used for administrative and educational purposes of the institution. Personal information collected by the
University will only be disclosed to third parties with the written consent of the person concerned, unless otherwise prescribed by law. For
further information, please refer to the University’s Statement on Privacy http://www.acu.edu.au/more_information/privacy/.
8. Supporting Documents Checklist (ensure all are attached otherwise assessment for your
application cannot occur)
1.
2.
3.
4.
5.
6.
7.
8.
Attachment detailing career disruptions (if applicable) Choose an item.
ORION print out of research outputs
Choose an item.
Flyer from Conference:
Choose an item.
A copy of your Research Plan endorsed by the ADR for the current year, and if available for the
previous year if you answered yes to being an ECR, or Transitioning
Choose an item.
Abstract/Paper to be presented:
Choose an item.
Acceptance letter/email:
Choose an item.
Other invitation letter (e.g. request to Chair Research Session): Choose an item.
Your approved staff connect leave
Choose an item.
9. Applicant Certification:
I hereby declare that the information provided in this form and attached documentation is
true and correct. I will comply with the conditions associated with the International
Conference Travel Grant (ICTG) Guidelines and submit a report to the Deputy-ViceChancellor (Research) via [email protected], Head of School, and the Faculty
Associate Dean Research within 3 months of my return to the University. I will claim all
expenses by the date advised in the letter of funding approval.
Signature:
Date:
10. Head of School
Comment below on the workload implications of absence, career planning, etc.
4|P a g e
Privacy statement. Australian Catholic University is committed to ensuring the privacy of all information it collects. Personal information
supplied to the University will only be used for administrative and educational purposes of the institution. Personal information collected by the
University will only be disclosed to third parties with the written consent of the person concerned, unless otherwise prescribed by law. For
further information, please refer to the University’s Statement on Privacy http://www.acu.edu.au/more_information/privacy/.
I approve this application
Yes
No
Name (please print): __________________________________________________
Faculty (or other Organizational Unit): ____________________________________
Campus_____________________________________________________________
Signature:
Date:
Note: Only forward approved and signed applications to the Associate Dean (Research). (If not
approved, inform the applicant of the outcome).
11. Associate Dean (Research)
Comment below on this application including
i)
ii)
iii)
the alignment of this conference with the strategic research direction of the Faculty,
the international standing of the conference,
and the research productivity and quality of research outputs of the applicant (See
response to question 7)
I approve this application
Yes
No
Name ________________________________
Signature _______________________________________ Date:____________
Note: If the application is NOT approved please do not forward to Research Services.
If the application is NOT approved please notify the applicant.
Supported Applications should be sent to [email protected] Research Services.
5|P a g e
Privacy statement. Australian Catholic University is committed to ensuring the privacy of all information it collects. Personal information
supplied to the University will only be used for administrative and educational purposes of the institution. Personal information collected by the
University will only be disclosed to third parties with the written consent of the person concerned, unless otherwise prescribed by law. For
further information, please refer to the University’s Statement on Privacy http://www.acu.edu.au/more_information/privacy/.