Application Form

CSA Class Grant and Contribution Program to SupportResearch, Awareness and Learning in Space Science and Technology

Application Form AO for Solar-Terrestrial Science Data Analyses

Receipt date

Application ID

(Reserved for internal use)

Notice to Applicants: Please read the Canadian Space Agency (CSA) Class Grant and Contribution Program Overview and Announcement of Opportunity (AO) for Solar-Terrestrial Science Data Analyses. Enter answers in all fields as indicated. Your application may not be considered if it is incomplete. It is the applicants responsibility to ensure that the application complies with all relevant federal, provincial, and territorial legislation and municipal bylaws. Please do not change the formatting of the application form.

SECTION 1 APPLICANT INFORMATION

Legal name of the organization (must be confirmed by the Office of Research)

Full name of principal investigator (PI)

Full name of representative from the Office of Research

Title/Position

Title/Position

Address

Address

Telephone

Fax

Telephone

Fax

Email

Email

Preferred language for correspondence

SECTION 2 PROJECT SUMMARY

Proposal title

Amount requested from the CSA (over a period of 36 months, starting 1 February, 2017)

Total Project Budget

(CSA + Other)

Months 1 to 12( $80,000)

Months 13 to 24( $80,000)

Months 25 to 36( $80,000)

Total( $240,000)

SECTION 3 SIGNATURES

Signature of principal investigatorDate

Full name of duly authorized representative

Title/Position

Applicants must mail one (1) paper copy of the application (with original signatures) and supporting documents to:

Solar-Terrestrial Science Data Analyses AO

c/o Isabelle Rivest

Sun-Earth System SciencesCanadian Space Agency

6767 Route de lAroport

Saint-Hubert, QC J3Y 8Y9

Also include an identical digital copy of the documents as a searchable PDF/A-formatted document file with all security features disabled on standard media (USB key, CD, or DVD).

Telephone

Fax

Email

I declare that I am the duly authorized representative for the organization.

SignatureDate

SECTION 4 SCREENING CRITERIA

The following five (5) criteria will be used by the CSA to screen the applications (see AO, Section 5.2 and Appendix A). Each criterion MUST have at least one box checked and the required information provided. Applications that fail to meet one or more criteria will be deemed noncompliant and will not be assessed further. Please check all applicable boxes and provide the requested information in the proposal.

1.The organization is a Canadian university or post-secondary institution.(See AO, Section 3.1)

2.This is the principal investigators only application under this Announcement of Opportunity.(See AO, Section 6.1)

3.The principal investigator: holds a PhD obtained from a recognized institution; is on the payroll of an eligible recipient; andholds a permanent, term, or contract position at therecipient institution for the duration of the fundingagreement.(See AO, Section 3.2)

4.The proposed project would make significant use of data being acquired by Canadian instruments on at least one of the following space missions:(See AO, Section 3.2)

5.The proposed project would develop or improve analytic and/or computational models of all or part of the geospace system.(See AO, Section 3.2)

Reserved for CSA use.

Result of pre-screening:

SECTION 5 PROJECT DETAILS

Please provide a short summary (maximum of 100 words) of the project. The summary should be based on the Summary section of the proposal (see AO, Section 4.2) and should be written using non-technical language for public release in case the proposal is accepted.

Please describe the project using key words (maximum of 10) separated by semicolons.

Project Proposal

Please attach a detailed description of the proposed research project, including objectives, methodology, and an explanation of the role and responsibilities of each person involved in the proposed research project. Please structure the proposal as described in the Announcement of Opportunity (see AO, Section 4.2). The project proposal will be assessed according to the evaluation criteria provided in the Announcement of Opportunity (see AO, Section 5.2 and Appendix A).

The cover page of the attachment must contain the title of the proposal, the name of the principal investigator, and the legal name of the organization requesting the grant. Please limit the document to a maximum of 10 pages using single-spaced text, with a 12-point font (minimum), and 2 cm borders (minimum) on standard letter-sized paper (8.5 x 11 inches).

SECTION 6 TEAM MEMBERS (PRINCIPAL INVESTIGATOR AND CO-INVESTIGATORS)

Please provide the names and contact information of the team members. Please complete and attach a Natural Sciences and Engineering Research Council (NSERC) Personal Data Form (Form 100) or NSERC Common Curriculum Vitae (CCV) for the principal investigator and a two-page curriculum vitae for each co-investigator. Please note that teams are limited to four (4) co-investigators.

Team Member 1

Full Name

Telephone

Title/Position

Email

Organization

Role in project

SECTION 6 TEAM MEMBERS (PRINCIPAL INVESTIGATOR AND CO-INVESTIGATORS) (continued)

Team Member 2

Full Name

Telephone

Title/Position

Email

Organization

Role in the project

Team Member 3

Full Name

Telephone

Title/Position

Email

Organization

Role in the project

Team Member 4

Full Name

Telephone

Title/Position

Email

Organization

Role in the project

Team Member 5

Full Name

Telephone

Title/Position

Email

Organization

Role in the project

SECTION 7 DETAILED IMPLEMENTATION SCHEDULE

Please attach a detailed implementation schedule for the project. The CSA recommends presenting the schedule in both a Gantt Chart and a tabular format with the following column headings: Work Breakdown Structure (WBS) identifiers, task name, task duration, start date, completion date, task dependencies (predecessor and successor task identifiers, relationship type, and lead or lag durations), and assigned leads for main task groups. The CSA recommends using the following WBS (add work packages as required to the provided structure):

WP1000 Project management

WP1100 Produce reports and plans, project control

WP1200 Participate in annual science or programmatic meeting

WP2000 Public/scientific outreach

WP2100 Participate in proposed conferences, workshops, and other scientific meetings

WP3000 Scientific research

WP4000 etc.

SECTION 8 DETAILED BUDGET AND SOURCES OF FUNDING

Please provide a detailed itemized budget, according to the following eligible CSA budget categories (see AO, Section 6.2).

Budget Breakdown ($)

Budget

Category

Description

and Details

Amount Requested from the CSA

Amount Requested from Other Sources

Total Project Budget

(CSA + Other)

Months

1 to 12

Months13 to 24

Months25 to 36

Total

Access fees

Accommodation and meal allowances

Acquisition, development,and printingof materials

Acquisition or rental of equipment

Consultant services

Costs related to obtaining security clearance

Data management

License and permit fees

Marketing and printing services

Materials and supplies

Participation fees at conferences, committees, and events

PST, HST and GST net of any rebate to which the recipient is entitled

Publication and communication services

Registration fees

Salaries and benefits

Training

Translation services

Travel

Overhead (administrative) costs (not to exceed 10% of all other eligible costs)

Other expenses (cannot be funded by the CSA)

TOTAL

SECTION 8 DETAILED BUDGET AND SOURCES OF FUNDING (continued)

Please identify any current and/or proposed funding sources using the information in the detailed budget.

Source of Funding(Name of organization and its funding program)

Contact Person(Full name, title and telephone number)

Type of Funding (In-kind, grants, etc.)

Funding Amount($)

% of Total Project Budget (excluding in-kind)

Confirmed Funding?

(Yes/No)

SECTION 9 SUGGESTED REVIEWERS

Please identify suggested reviewers for this proposal. (You may request that some individuals not be involved in the review of this proposal.)

Full Name

Organization

Telephone

Email

SECTION 10 OTHER

Please provide other documents to support your proposal (e.g., supplementary documents, NSERC Form 100 or CCV for principal investigator, two-page CVs for co-investigators, letters of support from co-investigators, letters of availability from providers of non-open data, letters of intent from organizations providing other sources of funding or in-kind contributions).

Applicant Declaration on Confidentiality, Access to Information Act and Privacy Act

The Applicant, through its duly authorized representative signing below, certifies as follows:

1. The Applicant authorizes the Canadian Space Agency (CSA) to share this application (including supporting material) with other federal and provincial government sources of assistance in order to facilitate cooperation between the CSA and other federal departments and provincial governments for the purposes of the Applicants application for such assistance as well as to review and assess applications to ensure that there is no duplication of assistance and to confirm compliance with all agreements. The Applicant also authorizes the CSA to gather from other federal departments and provincial governments the necessary information for such purposes.

2. Any relevant authorizations from individuals and other third parties have been obtained.

3. Necessary measures have been taken to protect the confidentiality of the information provided by the Applicant. This information is collected under the authority of the CSA Class Grant and Contribution Program to support Research, Awareness and Learning in Space Science and Technology Research Component and will be used to assess and select proposals. Personal information (such as contact information and biographical information) included in rejected proposals will be stored in a CSA Personal Information Bank for five years and then destroyed (Personal Information File no. ASC PPU045). Personal information included in successful proposals will be kept along with the proposal results for historical purposes. These data are protected under the Privacy Act. The Privacy Act states that the data associated with an individual and included in the assessed proposal can be accessed by the particular individual concerned, who has rights with respect to this information. This individual may, upon request, (1) be given access to his/her data, and (2) have incorrect information corrected or have a notation attached.

4. The Applicant understands that the information provided in this application (including supporting material) is subject to the federal Access to Information Act and Privacy Act.

I certify that I have read and clearly understand the above information and that the representation made herein is true and accurate.

Signature

Date

Duly authorized representative (typed name and title)

Supporting Documentation Form (for Organizations in Quebec)Relative to Chapter M-30 of the Act respecting the Ministre du Conseil excutif, R.S.Q., c. M-30.

Please review the relevant provisions of the Act, complete this form, have it signed by the Duly Authorized Representative, and return it to the CSA along with all the required supporting documents in your application.

Project Title

Legal Name of Entity/Organization

1) Under Section 3.11, is the Applicant (proposed payee) a municipal body or school body within the meaning of Section 3.6.2 of the Act?

Yes

No

2) Under Section 3.12, is the Applicant (proposed payee) a public agency as defined by Section 3.6.2 of the Act?

Yes

No

3) If there is a signed agreement between the Applicant and the CSA, will the agreement affect a government agency, municipal body, school body, or public agency within the meaning of the Act?

Yes

No

If you answered Yes to any of the above questions, you must:

Obtain the authorization from the Secrtariat aux affaires intergouvernementales canadiennes of the Quebec government before signing the funding agreement; and

Provide a copy of this authorization before the signature of the funding agreement.

If you answered No to all three questions, please submit this form, signed by the Duly authorized representative, with your application and any appropriate supporting documents.

I certify that I have read and clearly understand the above information and that the representation made herein is true and accurate.

Signature

Date

Duly authorized representative (typed name and title)

July 2016

The information collected on this form and appendices will be stored in the Personnel Information Bank of the CSA Grant & Contribution Program to support Research, Awareness and Learning in Space Science and Technology.

PROTECTED WHEN COMPLETED

Version franaise disponible

Page 1

English

Yes

No

Yes

No

Yes

No

Canadian instruments on ePOP/CASSIOPE

Canadian EFI instruments on ESA's Swarm

Yes

No

Compliant

Noncompliant

Franais