Fillable RD7004 Proposal Extended Internship Form (James Cook University of North Queensland)

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RD7004 Proposal Extended Internship Form (James Cook University of North Queensland)

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APPENDIX 1
JCU Internship Program for Research Higher Degree
Candidates
INSTRUCTIONS
Send your draft proposal to the GRS for checking prior to obtaining all signatures and submitting.
Student to complete this application in collaboration with their Primary Advisor and the Industry Partner
The start date of the internship has to be after expert review.
APPLICATION CHECKLIST
A complete internship application package must include the following :
□ The proposal application completed and signed by all parties. The memorandum (see Section 7) with signatures can be
submitted as a scanned PDF file.
□ The contact information for three external experts, from which one will be chosen as an arms-length reviewer (RD7004
Extended HDR Internship ONLY.)
□ Intern CV (a CV template is available on the GRS website)
□ Any supplementary documents (as applicable)
An incomplete application or a modified form will result in a delay in the internship evaluation process.
For more information, contact Dean Graduate Research JCU
Obtain required special permits, authorisations, or lic
enses (e.g. animal or human ethics, biohazards review) before
s
ubmitting the internship application.
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JCU HDR Internship Proposal Application
1. Research Proposal Summary
1.1. Title of project:
1.2. Length of Internship
Please indicate (x) the length of
internship
1 month Internship (RD7005)
( 5 month Internship (RD7004)
1.4. Keywords to identify
reviewers:
(3-10 specific
keywords; 50% technically related,
50% discipline-related)
1.5. Academic discipline:
1.6. Project purpose:
Please indicate (x) the
advancement you want to achieve
with this internship
Creation of new materials, devices, or products
Creation of new processes or services
Improvement of existing materials, devices, or products
Improvement of existing processes or services
2. Description of Proposed Project
2.1. Project title:
2.2. Project Abstract (Approx. 150 words):
The abstract must clearly summarize the project proposed. Please include: Background and problem, objectives, expected
results and relevance for the intern(s) and partner organization(s). This section will be used to recruit reviewers; it differs
from section 7.2.Public Project Overview, which must be written using simplified language understandable to a layperson.
1.3. Dates of Internship
Please specify the proposed start
and end dates of
the internship
please choose
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2.3. Background and review of relevant prior work (O
PTIONAL for 1 month internship, minimum 500 words):
2.4. General objective of the project broken down into sub-objectives, activities, themes, or subprojects, as
applicable:
2.5. Details of internships or subprojects:
For each intern or subproject, provide the following mandatory information:
a. Name of intern.
b. Specific objectives of the internship or subproject. Clearly state your [sub-] objectives so reviewers can
assess if they are achievable.
c. Methodologies. Provide enough detail so reviewers can determine if the proposed methodology is appropriate
and sufficient to achieve the [sub-] objectives.
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d. Timeline. We suggest using a Gantt chart to provide a timeline showing which task will be done when to
achieve each objective.
e.
Expected deliverables. Please describe the expected deliverables of the project (including the submis
sion of
a
completed
Final
Report
at
end of project.
f. Benefit to the intern.
g.
Interaction. Indicate the percentage (%) of time during the project that the intern will spend on-site at the
partner’s location.
The expected minimum interaction is 50%, if different, please include a justification.
% of partner interaction: % + % of academic interaction: % = 100%
h. Justification of interaction (if applicable).
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2.7. References:
i. Partner Interaction. Indicate what activities will be performed on-site at the partner organization.
2.6. Relevance to the partner organization:
Describe the partner’s proposed role in the project and how the partner will benefit from participating.
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3. Declarations
3.1. Will the proposed project be taking place outside of the lab or normal business environment of the
partner organisation?
Yes___ No___
If yes, please complete the following section to indicate what (if any) impact there may be on the environment.
a) Main characteristics of the location (i.e. physical description & coordinates).
b) Principal activity(ies): for each activity, list the environmental elements affected.
c)
Are authorizations, permits, or licenses required to undertake any activity during the internship?
Yes___ No
If yes, please list and include copies with your application.
3.2. Does the proposed project involve living human subjects (including conducting interviews) or human
remains, cadavers, tissues, biological fluids, embryos, or fetuses?
Yes___ No
If yes, the proposal must be approved by the relevant JCU Ethics Committee, and a valid Ethics approval is
required for the duration of the research project. Access to funding may be denied for projects that do not have
ethical approval.
Please note: the GRs will require a copy of the report to ensure compliance.
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3.3. Does the proposed project involve animal subjects?
Yes _ No
If yes, the proposal
must be approved by the JCU Animal Ethics Committee, and a valid approval from the
committee is required for the duration of the research project.
Please note: the GRS may request a copy of the report to ensure compliance.
3.4. Is a biohazards review required?
Yes No
If yes, the necessar
y review/report must be conducted in accordance with your university’s policies, and a valid
biohazards approval is required for the duration of the research project.
Please note: the GRS request a copy of the report to ensure compliance.
3.5. Have any participants declared a Conflict of Interest (COI) as part of this application?
Yes No
If yes, please at
tach the signed conflict resolution letter.
4. Participants
Duplicate relevant section(s) as needed for multiple interns or supervisors.
4.1. Primary advisor:
Name:
College:
Discipline:
JCU Address:
City:
Postal code:
Phone:
Email:
4.1.1. Is the primary advisor:
An owner or a co-owner of the partner organization:
Yes
No
A relative of an owner or co-owner of the partner organization:
Yes No
An employee of and/or a participant in the day-to-day management of the partner organization:
Yes No
For any additional academic advisors copy and paste Section 4.1. on added pages.
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4.2. Partner organization:
Legal name:
Operating name (if different):
Contact name:
Position:
Department:
Address:
City,, State:
Postal code:
Phone:
Email:
Website:
Partner s
ize (number of employees):
Legal
status:
4.3. Intern identified:
4.3.1. Intern in
formation
Name:
Degree program during internship :
Have you submitted your thesis for
examination:
Campus:
College:
Address at university:
Postal code:
Phone:
University email:
Citizenship
:
Gender:
4.3.2. Conflict of interest. Is t
he intern:
An owner or a co-owner of the partner organization:
Yes No
A relative of an owner or c
o-owner
of
the
partner
organization:
Yes
No
A
n
employee of and/or a participant in the day-to-day management of the partner organization:
Ye
s No
4.3.3. Demographic information. *O
PTIONAL*
Please indicate (x) if you are:
Indigenous
A person with a disability:
First in your family to attend university:
Yes
No
Student Number:
please choose
please choose
please choose
please choose
please choose
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5. Funding, Budget and Invoicing
5.1. Funding summary
For each five-month internship the partner must contribute $5,000 and JCU will contribute the remainder. The Candidate
will be paid a $15,000 stipend and receive up to $5,000 for research costs. The Primary
Advisor will receive $5,000 in
their IRA account.
For each 4-6 week internship the partner must contribute $1,000 and JCU will contribute the remainder. The Candidate
will receive an approximately $3,000 stipend (dependent on internship length) plus up to $1,000 for research costs. The
Primary Advisor will receive $1000 in their IRA/DBA account.
5.
2. Budget
Research Costs (Maximum $5,000 for five-month and $1000 for one-month internship.) Value
1. $
2. $
3. $
Total research costs $
5.3. Additional resources
The internship assumes that the partner will help the Primary Advisor supervise the intern. Please indicate if the
partner will provide the intern with any of the following additional resources and indicate their estimated value:
Additional resources Amount
Office supplies / stationery $
Use of equipment or specialized equipment $
Access to relevant company material, personnel $
Other, please specify: $
5.4. Invoicing Partner funds
Please describe any applicable invoicing requirements:
Address same as filled in Section 4.2.
If invoicing address different than Section 4.2, please fill out the following:
Please note: Costs can only be incurred after formal approval of the proposal and the receipt of the partner funds by JCU.
Have these funds been leveraged against other federal or state programs?
Yes No
If yes, please provide details:
Invoicing contact name:
Email:
Legal name:
Address:
City,State:
Postal code:
Phone:
Email:
0.00
5.5. Research Codes
(see listings on the Research Services website)
Socio-Economic Objectives (SEO) codes
Pure Basic %
%
Nature of Activity
Fields of Research FoR
%
Experimental & Developmental %
Applied Research%
Strategic Basic %
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6. Suggested Reviewers (RD7004 Extended HDR Internship Only)
Please provide the names and contact information of at least THREE (3) arms-length reviewers from which ONE (1)
will be chosen.
An arms-length reviewer must:
• Be a recognized expert in the research topics and technical aspects covered by the proposal;
• NOT be from JCU; and
• NOT have had any collaboration with the intern(s) or the academic advisor(s) or the partner(s) during the past
five (5) years or planned for the near future.
Please note that neglecting to suggest reviewers who qualify as independent will delay the review of your application.
Reviewer 1:
Name:
University:
Department:
Email:
Reviewer 2:
Name:
University:
Department:
Email:
Reviewer 3:
Name:
University:
Department:
Email:
Potential competing interest. *OPTIONAL*
Include potential reviewers whom GRS should not contact due to a potential competing interest in the proposed research.
Name:
University / Research Group:
Name:
University / Research Group:
7. Memorandum
The participants listed below confirm that the information presented accurately reflects their intention to apply to the
JCU HDR internship program. The participants have also agreed to set in place an internship based upon the
attached proposal. It is understood that the partner organization contribution shall be provided to JCU prior to
commencement of the internship. Upon approval of the internship, the GRS shall forward the funds to the university
as a research grant to the primary advisor, and the internship stipend will be paid to the HDR Candidate by the
university from the grant. Costs associated with this proposal as outlined in the budget can only be incurred after
formal approval of the proposal.
JCU Higher Degree by Research Candidates under the JCU HDR Internship Program and who are enrolled in
RD7004 or RD7005 and in receipt of a stipend are covered by JCU’s insurance. JCU HDR Internships must meet
any university policies regarding health, safety, and travel preparation requirements. All parties also agree that the
intern will provide the GRS with a final report and that all participants will complete an exit survey within one month
of project completion.
All parties involved with this program are bound by the standard intellectual property (IP) terms of the university
where the intern is enrolled; except where intellectual property is covered by separate agreements to which the
university and the partner organization are parties and that are active during the dates of the internship. By signing
this memorandum, you are acknowledging that you agree to the JCU IP policy at
https://www.jcu.edu.au/policy/research-management/intellectual-property-policy-and-procedure
The participants listed below agree that JCU can disclose the provided personal information included in this proposal
(e-mail, LinkedIn, Twitter, Facebook, etc.) to the program’s funding partners and that JCU can use them for the
purpose of communication and to evaluate the program and its outcomes during and after participants’ program
tenure. The participants also agree that JCU will post the title of the project, the public project overview, the name
of the partner(s) organization(s), the name of the intern(s), the name of supervisor(s) and the involved university on
the GRS website.
Internship participants (intern, Primary Advisor, and partner) further agree to the following addendum(s):
J
CU does not require, inspect, or enforce any additional terms as outlined by participants in the above addendum.
7.1. Title of the Project:
7.2. Public Project Overview:
Using simplified language understandable to a layperson; provide a general, one-paragraph description of the proposed research
project to be undertaken by the intern(s) as well as the expected benefit to the partner organization. (100 - 150 words)
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In signing this form, the participants listed below affirm their commitment to: (1) the JCU Code of Conduct, (2)
eliminating sexual harassment and sexual assault, and (3) meeting JCU standards in relation to appropriate staff-
student relationships, bullying and academic integrity. They acknowledge that the consequences for breaches of
that Code could include: removal from the supervisory relationship with that student in the first instance, and
disciplinary proceedings.
7.3. Participant Signatures:
Intern:
Name:
College
Signature: Date:
Primary Advisor:
Name:
College
Signature: Date:
Partner Organization:
Name:
Department:
Title/Position:
Organization:
Signature: Date:
GRS Representative:
Name:
Title/Position:
Signature: Date:
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Intern:
Name:
College
Signature: Date:
Primary Advisor:
Name:
College
Signature: Date:
Partner Organization:
Name:
Department:
Title/Position:
Organization:
Signature: Date:
Ammended proposal after revision (if required) Note: If no revisions were required, and the proposal was not changed, this section
does not need to be signed again.
Original proposal submitted to the GRS
GRS Representative:
Name:
Title/Position:
Signature: Date:
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RD7004 Proposal Extended Internship Form (James Cook University of North Queensland)

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Completed 25 July 2020

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