AISRF EMCR FELLOWSHIPS 2018-2019
APPLICATION FORM
NOTE: Please type as handwritten applications will not be accepted. Please set the text size at 12pt. All sections on this form should be completed. You are not limited to the space provided below and unless otherwise stated you can expand the items below as you see fit. Attachments should be added only where required.
1.	Applicant details
Title	First name 	Surname	

Position		
Department		
Organisation		
Organisation’s postal address		
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; AND
 	be based in Australia at the time of application	

3.	PhD degree (or equivalent research doctorate) details
Must have been awarded no more than 15 years prior to submission of application
Year awarded:		
Institution:		
State/Country:		
Field/s of research:		
(Please attach copy of PhD degree at the end of the application)
4.	Curriculum Vitae
Please attach a brief Curriculum Vitae highlighting any awards and invited presentations (maximum three (3) pages).
(Please attach the three (3) page CV at the end of the application)
5.	Publications list
Please attach a detailed publication list from the last five years (maximum three (3) pages).
Please separate your publication list into three headings:
1.	Refereed journal publications
2.	Conference proceedings
3.	Non-referred articles
(Please attach the three (3) page publications list at the end of the application)
6.	Advertising
Where did you find out about the Academy’s program?
Please tick one	 	Academy email register
 	Academy mailing list
 	Employer’s noticeboard or newsletter
 	Other
Please describe:	

7.	Field of research
Indicate the most relevant field of research under which your research falls, including the ANZSRC (Australian and New Zealand Standard Research Classification) code. The full list can be found here.
ANZSRC code (max 4 digits)		
Field of research		
Speciality		

If multidisciplinary, please indicate other relevant fields
ANZSRC code (max 4 digits)		
Field of research		
Speciality		
ANZSRC code (max 4 digits)		
Field of research		
Speciality		

8.	Education qualifications
Please include qualification/s, institution/s and date/s (most recent at top)
Qualification	Institution (include country if outside Australia)	Date(s)	

			

9.	Employment history
Please include positions held, employers and dates (mot recent at top)
Position held	Employer (include country if outside Australia)	Date(s)	

			

Details of activities
10.	Brief title of proposed research
Please provide a brief title of the proposed research to be advanced by the Fellowship (in no more than 20 words).
The summary should be written in a style understandable for the intelligent layperson and suitable for a press release.
(No more than 20 words)

11.	Description of proposed research
In no more than one (1) A4 page, describe the proposal in terms of what will be undertaken, where and with whom.
(Maximum length one (1) A4 page – this text box will expand)

12.	Selection Criteria
In no more than three (3) A4 pages, describe how the Fellowship will support you to develop and foster long-term relationships between Australian and Indian researchers taking account of the
•	Scientific merit of the proposed research visit
•	Demonstrated leadership potential in the context of your career to date
•	Extent to which the Fellowship will initiate or consolidate long-term collaborations between Australia and India
•	Expected outcomes intended to support the program’s objectives including your interest in increasing your understanding of Indian culture, science and research practices and systems.
(Maximum length three (3) A4 pages – this text box will expand)

13.	Visits or collaborations with India
Have you previously visited India or collaborated with Indian scientists? Please give details.

	

14.	Academy’s international programs
Have you previously applied for or participated in the Academy’s international programs? Please give details.

	

15.	Grants or Awards
Have you received any grants or awards during the past five years? Please give details.
Year	Grant or award	

		

16.	AISRF grants
Have you applied for an AISRF grant, or been a member of a team on behalf of which an application was submitted? If so, please provide details, including application numbers if available.

	

17.	Funding from other sources
Have you applied for funds to support this visit from other sources? If so, please provide details.

	

18.	Funding for overseas visits
Have you received funding from other sources for overseas visits during the past three (3) years? If so, please give details.

	

19.	Letter of support
Please attach a letter from your department/division head (on letterhead) supporting your research and this application.
(Please attach the letter of support at the end of the application)

Program details
20.	Total time spent on program
Travel to India may commence between 1 January 2018 and 30 June 2018 and must be between 3 and 9 months in duration. All travel must be completed by 31 March 2019.
	months	

21.	Projected commencement and completion dates
Travel to India may commence between 1 January 2018 and 30 June 2018 and must be between 3 and 9 months in duration. All travel must be completed by 31 March 2019.
Projected commencement date:		
Projected completion date:		

22.	Projected expenditure
Successful applicants may receive from the Academy a grant-in-aid of up to $40,500 towards an international return economy class airfare from Australia to the international airport closest to the host institution(s) (up to a maximum of $2,500), a once-off allowance for travel and medical insurances and visa costs (up to a maximum of $1,000), a once-off allowance travel within India for research related activities, including attending conferences (up to a maximum of $1,000) and a monthly living allowance ($4,000 per month or up to a maximum of $36,000). Please note that the grant-in-aid is not transferable.
Please provide the requested amounts that you are applying for: 
International return economy class airfare from Australia to the international airport closest to the host institution(s) (up to a maximum of $2,500)	$	
Once-off allowance for travel and medical insurances and visa costs (up to a maximum of $1,000)	$	
Once-off allowance travel within India for research related activities, including attending conferences (up to a maximum of $1,000)	$	
Monthly living allowance ($5,600 per month or up to a maximum of $36,000)	$	
TOTAL amount requested
(up to a maximum of $40,500)	$	

1.	
Host details
23.	Main host
Please provide details of the main host, including duration of visit
Title	First name	Surname	
			
Department		
Organisation		
Physical address		
Email address		
Phone number		
Duration of visit		days	
Please attach a recent CV of the host researcher (maximum three (3) pages) at the end of the application.
24.	Additional host
Please provide details of additional host (if applicable), including duration of visit
Title	First name	Surname	
			
Department		
Organisation		
Physical address		
Email address		
Phone number		
Duration of visit		days	
Please attach a recent CV of the host researcher (maximum three (3) pages) at the end of the application.
25.	Letter of invitation
Please provide a letter from each host researcher, on organisational letterhead, inviting you to their institution and commenting on the proposed collaboration, including an undertaking that all research in which you will be engaged will be conducted in accordance with relevant laws, codes and regulations.
(Attach letter of invitation from each host researcher at the end of the application)

Referees
26.	Main referee
Please provide the contact details of one referee (Australian or overseas) who will provide the Academy with a referee report. Only one written reference is required.
Title	First name	Surname	
			
Department		
Organisation		
Physical address		
Email address		
Phone number		
Please attach referee report at the end of the application.
27.	Additional referees
Please provide details of two Australian referees who may be contacted by the Selection Committee if further information is required. Additional referees are not required to provide a written referee report.
Title	First name	Surname	
			
Department		
Organisation		
Physical address		
Email address		
Phone number		

Title	First name	Surname	
			
Department		
Organisation		
Physical address		
Email address		
Phone number		

Important notices
Applications close 9am (AEST) Monday 11 September 2017.
Applications can be submitted by the applicant, a research office or, if from the private sector, a grants manager, will be considered. It is applicant’s responsibility to ensure that all the necessary documents have been submitted. Incomplete applications may be excluded from the selection procedure.
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.
Applications are considered carefully against the selection criteria by a committee of scientists with diverse expertise. The decisions of the committee are based upon 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 signature below:
Signature of applicant: 	

Name:		
Date:		

AISRF EMCR Fellowships 2018-2019
GUIDELINES FOR APPLICANTS

Deadline for applications:		9am (AEST) Monday 11 September 2017
Lodging your application:	Complete and submit the application form and supporting documents to: grants@science.org.au
Attach supporting documents in the following order
1.	Proof of Australian citizenship/Australian permanent residency (only for applicants not born in Australia)
2.	Copy of PhD Degree
3.	Short CV (max 3 pages)
4.	Detailed publication list (max 3 pages)
5.	Letter of support from home institution
6.	CV of each host researcher being visited (max 3 pages0
7.	Letter of invitation from each host researcher being visited
8.	Referee report
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.
Deadline for referee reports	9am (AEST) Monday 11 September 2017 (Refer to the Notes for Referees for details).
Notification of outcome:	The Academy expects that all applicants will be notified of the outcome in mid-November 2017.
Contact:				grants@science.org.au
NO LATE APPLICATIONS WILL BE ACCEPTED