Apply online for foundation funding

Details

Name of Applicant (Organisation/Group/Individual)

Contact Name

Email

ABN

Current Sources of Income or Funding

Address

Address 1

City

ZIP / Postal Code

State / Province

Country

Project

Project Title

Funding Requested (ex GST)

High Value Project

Yes

No

Complex Project

Yes

No

Project Duration

Commencement Date

Date

Time

Completion Date

Date

Executive Summary

MAIB Priority Area Addressed

Promotion and advancement of road safety.

Reduction in the frequency and severity of injuries resulting from motor accidents.

Improved access to quality medical, rehabilitation and long-term care services for those injured in motor accidents.

Development of new techniques and approaches to improve the quality management of injuries and long-term outcomes for those injured in motor accidents.

Focus of the project (Service Development)

Resource Acquisition

Policy Development

Improved Service Delivery

Focus of the project (Education)

Raising Awareness

Skill Development

Changing Behaviour

Please note that no funding will be transferred to research projects until written evidence of appropriate ethics approval has been received by the researcher for the research project.

Project Team

Project Manager

Experience

Team Members

Project Outline

Rationale

Objectives

Estimated Costs

The funding amount is exclusive of GST

If the purchase of equipment is required, please include quotes (at least two if over $5,000) with your application as well as details of the item to be purchased.

Salary including On-costs (Award / Level, Hours / Week)

Operation Costs

Total MAIB Funding Requested $

Total Budget (Project Costs plus In-kind Support)

In-kind Support

Details of funding obtained or sought from other sources

Cost Justification

Sustainability

Collaboration

Risk Management

Have the risks involved with the project been identified?

Has an assessment of the likelihood and consequences of the risks been done, if so please include a copy of the assessment?

Have strategies been developed to pre-empt and mitigate the occurrence of a risk?

Who is responsible for managing risk?

How are new risks going to be identified as they emerge?

Evaluation

How will progress toward the achievement of the objective/s be measured throughout the project?

How will achievement of the objective/s be identified?

Communication

How will the outcomes and the knowledge gained from the project be communicated to others?

Signature of Authorising Officer

Position

Name

Date

Time

I am duly authorised on behalf of my organisation to submit this application.

Yes