NORTHERN RESEARCH AWARDS Common Application Form 2017_2018

APPLYING FOR:UofA NORTHERN RESEARCH AWARDS

DATE mm/dd/yyyy

SECTION A: STUDENT INFORMATION

FIRST NAME LAST NAME DEPARTMENT

STATUS STUDENT ID E-MAIL

PERMANENT ADDRESS

CITY PROVINCE POSTAL CODE TELEPHONE

ACADEMIC LEVEL GRADUATE PROGRAM YEAR OF PROGRAM

SECTION B: DISCIPLINE, PROJECT, RESEARCH

DISCIPLINE

PROGRAM OF STUDY

NAME OF SUPERVISOR E-MAIL OF SUPERVISOR

1

NSTP

Amountrequested

Amountrequested

GEOGRAPHIC FOCUS

Other

FIELDWORK LOCATION COORDINATES : Please use decimal degrees

If your fieldwork is outside of Canada, please select circumpolar country and name location below:

Name location of fieldwork in the circumpolar country selected:

2

Refer to information in the guidelines and maps to identify your fieldwork location.

Name location of fieldwork

Have you received prior funding from NSTP and/or UANRA? (Please list year/s awarded funding)

Yes No Year/s

PROJECT TITLE

BRIEF DESCRIPTION AND SIGNIFICANCE OF PROJECT (maximum 500 words)

3

WORD COUNT

DETAILED RESEARCH PROPOSAL should include scope and rationale for the research;

methods; references; schedule. Please refer to attached guidelines for more information.

PLEASE PRINT YOUR DETAILED PROPOSAL IN SEPARATE PAPER AND INCLUDE IT

WITH THE PRINTOUT OF THIS COMPLETED APPLICATION FORM

Maximum 1500 words, excluding references and schedule - please include final word count.

Required Font Type of detailed proposal: TIMES NEW ROMAN

Required Font Size: 11

Required Spacing: 1.5

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SECTION C : PERIOD IN THE NORTH, BUDGET

Total estimated number of days in the north:

From To

Please provide detailed explanation if the duration of your field work is less than a total of 21 days

BUDGET: Please work with your supervisor on what YOUR field research costs are within their broader lab (Total Project costs). Make sure you look at what is eligible for each funding source - see next page. OPEN in ADOBE ACROBAT!! Not Google or your web browser

Expense type NSTP request

max $4,000.00

Northern Awards request max $8,000.00

Total request

max $8,000.00 Total project cost

Travel Air, ground , accomodations or other

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________ Subsistence Per diem or cost of food (per diem is $40 per day X's # of days out )

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________ Other costs You may include costs such as freight; translation; research license application fee; reporting, etc.

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________

________________ $ ______________ $ ______________ $ ______________ $ ______________

TOTALS $ ______________ $ ______________ $ ______________ $ ______________

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BUDGET JUSTIFICATION: Be clear in why you need supplemental funds to carry out your research. Rememberthe funds you are applying for are for the field research portion of your project.

SUBSISTENCE ( Detail costs and justify)

OTHER COSTS (Detail costs and justify)

6

TRAVEL (Detail costs and justify)

OTHER SOURCES OF FUNDING APPLIED FOR AND/OR FUNDS RECEIVED (You are required to include information about othersources of funding including in-kind support as both the UANRA and NSTP provide only supplementary funding. Please refer to the guidelines for more information)

GRANTING AGENCYDATE APPLIED mm/dd/yyyy

AMOUNT REQUESTED

AMOUNT RECEIVED

SECTION D : NORTHERN RESEARCH LICENCE(S) / PERMIT(S) AND COMMUNITY ENGAGEMENT & OUTREACH Please attach copy of licence/permit with your application

NAME OF ORGANIZATION

DATE APPLIED (mm/dd/yyyy) APPROVED

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IN-KIND SUPPORT (Please provide detailed information on the sources and type of in-kind support. Use additional sheet if needed.)

USE THIS SPACE TO INCLUDE ADDITIONAL INFORMATION REGARDING LICENCES AND PERMITS (for example, if your licence or permit is pending, indicate when you expect to receive it)

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Please outline your plans for communicating your research and its anticipated outcomes to northern communities and stakeholders. What methods would you adopt to connect and engage with communities situated closest to the location of your field work?

Supervisor name Signature

Confirm Supervisor's Evaluation Form submitted to your supervisor:

UAlberta North Signature form attached: (You are not required to have RSO sign the final section of the signature form)

SECTION E: DECLARATIONS AND SIGNATURESDECLARATION OF STUDENT AND SUPERVISOR: We certify that: 1) the research is part of the student's thesis work; 2) we are aware that participation in the project must be in accordance with University of Alberta obligations and all applicable research policies and procedures; 3) The information provided in the application is complete and accurate; AND 4) we fully understand and accept reporting obligations and other deliverables associated with this grant.

We hereby confirm that this proposed research and its associated activities are compatible with the UAlberta Research Policies and with the ACUNS Ethical Principles for the Conduct of Research in the North; and we have taken necessary steps to acquire the relevant research licence (s) / permit(s).

In signing, we recognize the necessity to manage, in a responsible fashion, all monies awarded. In signing, we are also indicating that we accept the responsibilities as outlined.

OUTLINE OF ESPONSIBILITIES OF STUDENT WITH THE SUPERVISOR: Scope, budget, grad student rights, intellectual property, community consultation/s, collection permit/s, affiliations/collaborations. Certification: Human Ethics; Animal care; Biohazard. Research Licenses (NT, Nunavut, National Parks, etc.). Reporting: Funders, Licensers, Communities etc.

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Send electronic copy to: northres@ualberta.caPlease state clearly in the subject line your name and common application form. e.g. John Smith – Common Application Form - October 2017

Submit one hard copy to: UofA Northern Research Awards Committee Ring House 3, University of Alberta

Student name Signature

NORTHERN AWARDS

Supervisor's Evaluation Form

Note to the Supervisor: The information you provide on this evaluation is especially important for adjudication of the proposal in the competition (UofA Northern Awards and NSTP). Your evaluation will also be used by the adjudication committee to nominate a candidate for NSTP's three special awards. Please provide an evaluation of the student as well as the project. Focus comments on the quality of the research, the training component of the project, how the fieldwork relates to the student's studies, and how he/she will benefit from the experience. Also indicate if any support is provided to the student/project from you and/or the Department.

SUPERVISOR NAME STUDENT NAME

DEPARTMENT

EVALUATION OF THE PROPOSED RESEARCH PROJECT

ABILITY OF STUDENT/TRAINING COMPONENT: What qualities/abilities does this student bring to this project that will see it brought to successful completion, and how will they benefit from their experience?

ADDITIONAL SUPPORT: What support (financial and other) will be provided to the student/project from you/the Department. Indicate steps taken to accommodate any shortfalls in the student's funding for this project.

DO NOT RETURN THIS FORM TO THE APPLICANT. PLEASE FORWARD DIRECTLY TO: northres@ualberta.ca