APPLICATION FORM
1.	Applicant details
Title	First name 	Surname	
			
Organisation		
Department		
Organisations’ postal address		
Country		
Email address		
Phone number (incl. area code)	Business hours 	Mobile	

Date of birth		
Country of birth		
2.	Applicant eligibility
Tick the most relevant box in this category	be either:
 	an Australian citizen
 	an Australian permanent resident or hold a valid 	student or working visa	
Tick the most relevant box in this category	be currently enrolled in university or hold a degree:
	currently enrolled in university
	bachelor degree which must have been received within 	ten (10) years prior to 1 January 2018 (i.e. conferred on 	or after 1 January 2008)
	master degree which must have been received within 	seven (7) years prior to 1 January 2018 (i.e. 	conferred on or after 1 January 2011)
	PhD which must have been received within five (5) years 	prior to 1 January 2018 (i.e. conferred on or after 1  	January 2013)	
Confirm all three in this category	Applicants must additionally:
	hold a passport valid until at least April 2019, and
 	be 18 years of age or over
	be based in Australia at the time of application	
3.	Field of research
Please list the field of science most relevant to your project, including ANZSRC code (Australian and New Zealand Standard Research Classification) e.g. 0703; Agricultural and Veterinary Sciences; Crop and Pasture Production.
ANZSRC code (max 4 digits)		
Field of research		
Speciality		
If the research is multidisciplinary, please indicate other relevant fields (max 2 fields)
ANZSRC code (max 4 digits)		
Field of research		
Speciality		
ANZSRC code (max 4 digits)		
Field of research		
Speciality		
4.	Reasons for application
Provide your reasons for applying in no more than two A4 pages, covering the points below.
1.	Aims, objectives and motivation for participating in Falling Walls Australia (include originality of the proposed project/idea, potential for innovation, and the expected impact and feasibility of the proposed project/idea). 
2.	What is your capacity to contribute to this event?
3.	How will attending this event contribute to your career? 
(Maximum length two A4 pages – this box will expand)

5.	Referee
Referee Information
Name, address and contact details of one referee (Australian or overseas) who will complete the Referee Report form. Only one written reference is required. 
Title	First name 	Surname	
			
Organisation		
Department		
Organisations’ Postal address		
Country		
Email address		
Phone number (incl. area code)	Business hours 	Mobile	
			
Referee reports can be sent to the Academy by the applicant or by the referee.
Important notices
Applications close 5pm (AEST) Monday 28 May 2018.
Applications can be submitted by the research/grants office or by the applicant. It is the applicant’s responsibility to ensure that the application forms and supporting documents have been submitted. Incomplete applications will be excluded from the selection procedure.
The application process has two steps. Applications must also be submitted online at the official Falling Walls Lab website by the same due date. More information on the application process.
The Academy will acknowledge receipt of this application within 48 hours following the grant deadline. If you do not receive acknowledgement that this application has been received please contact the Academy immediately. No late applications will be accepted.
Australian applications will be considered carefully by an evaluation panel put together by the Australia Academy of Science with diverse expertise. The decisions of the panels are based on the assessed competitiveness of the proposal. The Academy is not able to enter into discussion or correspondence regarding the reasons why an application is successful or not.

Please insert electronic signatures below:
Signature of applicant: 	

Name:		
Date:		

Falling Walls Lab Australia 2018

GUIDELINES FOR APPLICANTS
Deadline for applications:		5pm (AEST) Monday 28 May 2018
Lodging your application:	Complete and submit the application form to: grants@science.org.au
	Complete and submit the application form on the Falling Walls Lab website
Attach supporting documents: 	1.	Copy of passport (ID page only) valid until at least 	April 2019
2.	Colour photo (image must be larger than 250x300 pixels and suitable for a program booklet)
3.	Referee report or letter of reference
Receipt of application form:	The Academy will acknowledge receipt of this application within 48 hours following the grant deadline. If you do not receive acknowledgement that this application has been received please contact the Academy immediately. No late applications will be accepted.
Notification of outcome:	The Academy expects that all applicants will be notified of the outcome in early July.
Contact:				grants@science.org.au
NO LATE APPLICATIONS WILL BE ACCEPTED