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Accelerating Commercialisation Expression of Interest Form
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Accelerating Commercialisation Expression of Interest Form
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Receipt

Accelerating Commercialisation Expression of Interest Form
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Instructions

Accelerating Commercialisation Expression of Interest Form
Fields marked with  * are required
About Accelerating Commercialisation
Accelerating Commercialisation is an element of the Entrepreneurs' Programme. It is a highly competitive, merit based programme and only the strongest applications will be successful. Accelerating Commercialisation encourages and assists small and medium businesses, entrepreneurs and researchers to commercialise novel products, processes and services.
Completing this form
Please read the Customer Information Guide before completing this Expression of Interest.
Important information
Expression of Interest forms will be used to determine whether you are suitable to progress to an application. Completing an Expression of Interest form provides no assurance or guarantee of receiving funding assistance or becoming a member of the Portfolio. A major benefit to Accelerating Commercialisation participants is having access to a Commercialisation Adviser to guide them through the commercialisation process. Commercialisation Advisers are independently contracted by the Department and have extensive experience in commercialisation. Your completed Expression of Interest form may be provided to a Commercialisation Adviser for review and comment.
Disclosure of information
The Commonwealth’s use and disclosure of your information (provided in this application or otherwise) is set out in the Accelerating Commercialisation Customer Information Guide.
Google Places
The address search fields in this form use Google Places to help fill in the address details. By using this feature you agree to be bound by Google’s Terms of Service and are subject to Google’s Privacy Policy.
Getting help
If you require assistance completing this form please contact us on 13 28 46 or at business.gov.au. Our website and staff can help you with forms, finding business information and services and allow you to provide feedback, comments or suggestions. You should also read and understand the Customer Information Guide and general funding agreement before completing an application. View these documents at business.gov.au.
Requirements
This form functions best when it is completed using the most recent version of your internet browser. This form is not compatible with Internet Explorer 8 or earlier browsers. If you are using an earlier browser version, you may have difficulty in displaying the form correctly or it may not display at all.
Unsubmitted forms
You can save your unsubmitted form by clicking SAVE FOR LATER at the top of this form. This form has a Tracking Code displayed in the top right corner. Please make a note of this Tracking Code for your records. The Tracking Code is required to reopen your saved form and you will need to provide this code if you require assistance with your form. Incomplete, unsubmitted forms are retained for a maximum of 30 days before being deleted. Your active form should be saved during this 30 day timeframe otherwise it will be deleted and you will need to start a new form.
Attachments
All attachments marked as required must be attached before your application can be submitted. Files with ".pdf, .rtf, .doc, .docx, .xls, .xlsx" extension types can be uploaded. Total file size of all attachments in the application should not exceed 20MB. Please note that there is a size limit of 2MB per attachment.
Submitting your form
You may apply for Accelerating Commercialisation at any time. You will be provided with a receipt to confirm that your submission has been successful. Please keep this receipt for your records by using the “Download the form and receipt” link or by emailing yourself a copy of the receipt and submission. Both of these options are available in the “To keep a copy of the completed form” box on the Submission Complete page. If you have any enquiries relating to submission of your form, you will need to provide your receipt number.

Eligibility

Accelerating Commercialisation Expression of Interest Form
Fields marked with  * are required

Eligibility

This section will help you determine whether you are eligible to apply.
Do you have a novel product, process or service that you wish to commercialise?
Do you intend to trade your commercialised product, process or service outside the state or territory of your place of business?
Are you named by the Workplace Gender Equality Agency as an organisation that has not complied with the Workplace Gender Equality Act 2012 (Cth)?
To check the list of businesses named by the Workplace Gender Equality Agency go to this link: Workplace Gender Equality Agency
You are not eligible to apply for commercialisation guidance. Please refer to the Customer Information Guide.
This form is an Expression of Interest Form. The following is provided as eligibility guidance for applications under Accelerating Commercialisation, if you wish to proceed beyond seeking Commercialisation Guidance.
At the time of an application, you must be one of the following:
A non tax-exempt company incorporated under the Corporations Act 2001 that is registered for GST and its trading activities form a sufficiently significant proportion of its overall activities as to merit it being described as a trading corporation; or are a substantial and not merely peripheral activity of the corporation. The commercialisation office of an Australian University or Publicly Funded Research Organisation (PFRO); or An eligible partner entity that is a company; or An individual or researcher, partnership or unincorporated trustee who agrees to form a non tax-exempt company incorporated under the Corporations Act 2001 if your application for Accelerating Commercialisation funding is successful; or An incorporated trustee applying on behalf of a trust.
And you are able to satisfy the following:
You have received Commercialisation Guidance; You have a novel product, process or service you wish to commercialise and trade to customers external to the state or territory of your place of business; You comply with the Workplace Gender Equality Act 2012 (Cth).
If you are seeking grant funding, you must also satisfy the following:
You meet the turnover limits specified in the Customer Information Guide; You have ownership, access to, or beneficial use of, any intellectual property that is the subject of, or is necessary to carry out your commercialisation project; You are able to demonstrate an ability to fund at least 50 per cent of the cost of the eligible project, other than from Government Grant Sources; and Your proposed expenditure is for an eligible commercialisation project as specified in the Customer Information Guide.
If you are seeking to join the Portfolio only, you must also satisfy the following:
You have received Commercialisation Guidance; You meet the turnover limits specified in the Customer Information Guide; You have a commercialisation strategy that aims to achieve at least one of the following: Complete the development of a novel product, process or service; Prove commercial viability of a novel product, process or service; or Expand commercialisation of your novel product, process or service in existing markets or into new markets; and You have ownership, access to, or beneficial use of, any intellectual property that is the subject of, or is necessary to carry out your commercialisation project.

Applicant information

Accelerating Commercialisation Expression of Interest Form
Fields marked with  * are required

Joint application

Joint applications by one or more entities are acceptable, provided you have a lead applicant who is the main driver of the project and is eligible.
Is this a joint application?
The lead applicant must complete this form. If you are unsure of the status of your application as a joint application please contact us on 13 28 46 or at business.gov.au.
Please list all the joint project partner organisations for this application, starting with the lead applicant. If the lead applicant is a trustee of a Trust, enter the Trust’s ABN.
Please enter the ABN of all Australian partners in the joint application and click the Validate button to retrieve your registration details.

You will be required to provide a copy of the trust documents showing the relationship of the incorporated trustee to the trust.
This is the ABN registered for the trustee as an entity in its own right.
The entity name refers to the name that appears on all official documents or legal papers. The entity name may be different from the business name.
Your business may have registered one or more business names. If you operate under a business or trading name you can enter alternate name(s) here. If your business or trading name is not listed here select ‘Other’.
If you have not registered your business name but trade under another name enter it here.
Upload a copy of the trust documents showing the relationship of the incorporated trustee to the trust
File:
Are there international project partners?

International project partners

Please enter details of all international project partners

International project partner

Organisation details

Do you have an ABN?
Do you have an ACN?

Type of applicant

In this section you must indicate what type of entity you operate under.
Select which type of entity your organisation is: *
For Accelerating Commercialisation, a company is Incorporated under the Corporations Act 2001; and its trading activities form a sufficiently significant proportion of its overall activities as to merit it being described as a trading corporation; or its trading activities are a substantial and not merely peripheral activity of the corporation.
To be eligible the company must be incorporated in Australia under the Corporations Act 2001, have an ABN and an ACN and be non-tax-exempt.
For trustees applying on behalf of a trust, you must enter the details of the trustee acting in its capacity as a trustee on behalf of a trust.
A Commercialisation Office is an entity of a publicly funded research organisation (PFRO) or a company controlled by one or more PFROs, that assists researchers in commercialising their intellectual property. A PFRO is a higher education provider listed in Table A and Table B of the Higher Education Support Act 2003 as well as Federal, State and Territory Government departments or agencies which undertake publicly funded research.
If the application is successful the individual warrants they will form a non tax-exempt company under the Corporations Act 2001.
If the application is successful the partnership warrants they will form a non tax-exempt company under the Corporations Act 2001.
An eligible partner entity is an entity whose primary purpose is research but also looks to commercialise the resultant intellectual property.
If the application is successful the researcher warrants they will form a non tax-exempt company under the Corporations Act 2001.
If the application is successful the unincorporated trustee warrants they will form a non tax-exempt company under the Corporations Act 2001.

Applicant details

These details have been populated from the first collaboration partner entered above.
You will be required to provide a copy of the trust documents showing the relationship of the incorporated trustee to the trust.
This is the ABN registered for the trustee as an entity in its own right.
The entity name refers to the name that appears on all official documents or legal papers. The entity name may be different from the business name.
Your business may have registered one or more business names. If you operate under a business or trading name you can enter alternate name(s) here. If your business or trading name is not listed here select ‘Other’.
If you have not registered your business name but trade under another name enter it here.
Upload a copy of the trust documents showing the relationship of the incorporated trustee to the trust
File:

Trust and trustee details

These details have been populated from the first collaboration partner entered above.
As a minimum you need to provide us with the name of the Trustee of the Trust as shown in the Trust documents
This is the ABN registered for the trustee as an entity in its own right.
The entity name refers to the name that appears on all official documents or legal papers. The entity name may be different from the business name.
Your business may have registered one or more business names. If you operate under a business or trading name you can enter alternate name(s) here. If your business or trading name is not listed here select ‘Other’.
If you have not registered your business name but trade under another name enter it here.
Upload a copy of the trust documents showing the relationship of the incorporated trustee to the trust
File:
You will be required to provide a copy of the trust documents showing the relationship of the incorporated trustee to the trust.
This is the ABN registered for the trustee as an entity in its own right.
The entity name refers to the name that appears on all official documents or legal papers. The entity name may be different from the business name.
Your business may have registered one or more business names. If you operate under a business or trading name you can enter alternate name(s) here. If your business or trading name is not listed here select ‘Other’.
If you have not registered your business name but trade under another name enter it here.
Upload a copy of the trust documents showing the relationship of the incorporated trustee to the trust
File:

ANZSIC details

What is the applicant’s main business activity under the Australian and New Zealand Standard Industrial Classification (ANZSIC)?
The ANZSIC codes and titles are available from the Australian Bureau of Statistics (ABS) website. Phone 13 28 46 if you require assistance.

Address details

Provide your Business Street Address (Australian Head Office)
This widget uses Google Places. In order to use it you need to comply with the Google Place API Policy. To summarise

Your Terms of Use and Privacy Policy must be publicly available. You must explicitly state in your applications Terms of Use that by using your application, users are bound by Google’s Terms of Service. You must notify users in your Privacy Policy that you are using the Google Maps API(s) and incorporate by reference the Google Privacy Policy.
Once you have complied with Google's policy you should hide this note.
Google Places - start entering your address to search Google Places and, if found, the form will autofill the fields below. If not found, please enter the address details directly in the fields below.
Country *
Please enter the country’s two letter code. You can find the two letter code by clicking this link to the ISO resource and selecting 'Country codes' above the search field.
Is the Postal Address the same as the Business Street Address entered above?
Provide your Postal Address
This widget uses Google Places. In order to use it you need to comply with the Google Place API Policy. To summarise

Your Terms of Use and Privacy Policy must be publicly available. You must explicitly state in your applications Terms of Use that by using your application, users are bound by Google’s Terms of Service. You must notify users in your Privacy Policy that you are using the Google Maps API(s) and incorporate by reference the Google Privacy Policy.
Once you have complied with Google's policy you should hide this note.
Google Places - start entering your address to search Google Places and, if found, the form will autofill the fields below. If not found, please enter the address details directly in the fields below.
Country *
Please enter the country’s two letter code. You can find the two letter code by clicking this link to the ISO resource and selecting 'Country codes' above the search field.

Website address

Are you currently dealing with a Commercialisation Adviser?

Background

Please provide a brief history of your business

Project site address

Will the project’s activities occur solely at the above listed head office address?
A project site address must be a street address, not a postal address.

Site Address

This widget uses Google Places. In order to use it you need to comply with the Google Place API Policy. To summarise

Your Terms of Use and Privacy Policy must be publicly available. You must explicitly state in your applications Terms of Use that by using your application, users are bound by Google’s Terms of Service. You must notify users in your Privacy Policy that you are using the Google Maps API(s) and incorporate by reference the Google Privacy Policy.
Once you have complied with Google's policy you should hide this note.
Google Places - start entering your address to search Google Places and, if found, the form will autofill the fields below. If not found, please enter the address details directly in the fields below.
Country *
Please enter the country’s two letter code. You can find the two letter code by clicking this link to the ISO resource and selecting 'Country codes' above the search field.

Latest financial year figures

We use this data to better understand your business and to help us develop better policies and programs.
Has the applicant existed for a complete financial year? *

Latest Financial Year Figures

All amounts in the table below must show a whole dollar value e.g. $2 million should be presented as $2,000,000. The turnover value must be that of the incorporated entity that is submitting the Expression of Interest and each of its related entities over each of the last three financial years. Turnover is the revenue earned from ordinary activities.
FY
FY
FY

Company

Sales Revenue (Turnover)
Not applicable
Not applicable
Not applicable
You can add lines for more entities (up to a total maximum of 10 lines).
Total revenue from the sale of goods and services, as reported in the applicant’s Business Activity Statement (BAS).
Has the applicant existed for a complete financial year? *

Financial Year Figures

All amounts in the table below must show a whole dollar value e.g. $2 million should be presented as $2,000,000. The turnover value must be that of the incorporated entity that is submitting the Expression of Interest and each of its related entities over each of the last three financial years. Turnover is the revenue earned from ordinary activities.
FY
FY
FY
Sales Revenue (Turnover) *
Not applicable
Not applicable
Not applicable
Total revenue from the sale of goods and services, as reported in the applicant’s Business Activity Statement (BAS).
Export Revenue *
Not applicable
Not applicable
Not applicable
Total revenue from export sales, as reported in the applicant's Business Activity Statement (BAS).
R&D Expenditure *
Not applicable
Not applicable
Not applicable
Expenditure on Research and Development, i.e. creative work undertaken on a systematic basis in order to increase the stock of knowledge, including knowledge of man, culture and society, and the use of this stock of knowledge to devise new applications.
Taxable Income *
Not applicable
Not applicable
Not applicable
Taxable income or loss as per the Applicant's Business Income Company Tax Return Form.
Employees, including working proprietors and salaried directors (headcount) *
Not applicable
Not applicable
Not applicable
Number of individuals who are entitled to paid leave (sick and holiday), or generate income from managing the business.
Independent contractors (headcount) *
Not applicable
Not applicable
Not applicable
Number of individuals engaged by the business under a commercial contract (rather than an employment contract) to provide employee-like services on site.

Ultimate holding company

Does the applicant have an Ultimate Holding Company?
You will be required to provide a copy of the trust documents showing the relationship of the incorporated trustee to the trust.
This is the ABN registered for the trustee as an entity in its own right.
The entity name refers to the name that appears on all official documents or legal papers. The entity name may be different from the business name.
Your business may have registered one or more business names. If you operate under a business or trading name you can enter alternate name(s) here. If your business or trading name is not listed here select ‘Other’.
If you have not registered your business name but trade under another name enter it here.
Upload a copy of the trust documents showing the relationship of the incorporated trustee to the trust
File:

Project details and funding

Accelerating Commercialisation Expression of Interest Form
Fields marked with  * are required

Project title and description

If your application is successful, the details you provide below will be published on the departmental website. Published project details will include: name of the applicant title of the project a description of the project and its intended outcomes amount of funding awarded.
Provide a project title. *
If the application is successful, this project title may be used by the Australian Government in published material.
Provide a brief project description for publication on our website. *
Ensure your project description focuses on your project’s key activities and outcomes. Explain what it is you are going to do and how it will benefit your business. If the application is successful this project description may be used by the Australian Government in published material. {Example Project Description: Transition Pty Ltd is an injection moulding company that manufactures plastic products and now intends to extend its business into the healthcare sector by manufacturing sterile plastic equipment for medical use.}

Summary of activities and outcomes

You may attach up to 3 A4 pages for diagrams supporting your project.

Attachment

Attachment
File:

Project plan

You must provide a plan of the project activities you will conduct including timetable and budget for all significant activities.
Project Plan
File:

Project milestones and key activities

Provide details on the activities occurring at each milestone and enter the estimated eligible project costs into the table. Create new milestones as appropriate. The start date of milestone 1 is the expected project start date. The end date of your last milestone activity will be the project end date.

Milestone

Project duration

Project budget

Provide details on your eligible project costs over the life of the project.
Amounts must be GST exclusive. {Note, the minimum grant amount under the programme is $0 and the maximum grant amount is $1 million.} We only provide grant funding based on eligible expenditure. Refer to the Programme Guidelines for guidance on eligible expenditure.
Cost item
Total

Sub total eligible expenditure
Ineligible costs
Total project costs

Source of funding

Complete the table below to show how the applicant will fund the eligible project costs. Amounts must be GST exclusive. Note, the minimum grant amount under the programme is $0 and the maximum grant amount is $1 million.
The project cannot be funded by this grant in conjunction with any other Commonwealth grant. The total government grant percentage including non-Commonwealth government funding cannot exceed 100%.

Other government contribution sources

If a figure greater than $0 was entered in Part c) Other non-Commonwealth Government Funding in the table above, provide details of the other government grant funding.

Contribution Source

Your contribution

To describe your funding strategy for the project complete the table below and provide the following attachments.
Fund Type
Amount ($A) *
Description on the source of funding *
Cash flow
Loans
Equity
Other
Total
Please upload the following: Evidence of conditional support from your Board (or if there is no Board, support from the owner or chief executive officer) that the business can complete the project and meet the project costs not covered by grant funding. Evidence to support the project funding strategy.An Accountant Declaration to confirm your business can fund its share of the project costs. You must use the template provided as an Appendix in the Programme Guidelines.

Attachment

Evidence
File:

Applicant bank account details

Provide your bank account details below so we can pay your grant funds if you are successful.

Supportive documents

Examples of supporting documents are equipment supplier quotes, contractor quotes, invoices etc. You do not need to submit these with this application form. However, if your application is successful you will be required to submit these documents before the grant agreement is finalised. You can find more details in the Programme Guidelines.

Funding

What are you interested in applying for under Accelerating Commercialisation?

Project details

Are you developing a product, process or service? *
Briefly describe the novel product, process or service that you are intending to commercialise.
How is it novel or innovative? For example, how is it different from existing products currently available?
What technology is core to the invention? (this is the substance of the invention, not its use)
Application of science and technology to living organisms, as well as parts, products and models thereof, to alter living or non-living materials for the product of knowledge, goods and services
Programs, procedures and data associated with the operation of a computer system, and includes website design
Physical computer, peripheral input and output devices, combination of software and hardware components interacting in a systematic way
Manufacturing:

Technology that assists in the fabrication and/or assembly of goods or services; does not have a biotechnology basis; does not contain significant innovation in software or hardware necessary for the successful running of the innovation.

Engineering and Design:

A broad classification capturing innovations that do not fall within other categories. May include (but not limited to) mechanical engineering, electrical engineering, civil engineering, chemical engineering, food engineering, food technologies and manufacturing, materials engineering, process engineering (including process enhancements), minerals processing, product design enhancements, industrial design, industrial processing
What is the target market for the novel product, process or service? *
Including but not limited to: Products and components for Automotive/aviation/marine transport (Boats, submarines etc.), novel manufacturing process related to Automotive, Aviation and Marine, services targeting Automotive, Aviation and Marine
Including but not limited to: banking, insurance and management systems, communications and media.
Including but not limited to: Defence related products and services, products for home and public safety, security products and services, including software and communications security, industrial safety equipment not related to a specific sector.
Including but not limited to: Education programs, tools, on-line tools to aid in learning, delivery aids, innovations to improve teaching.
Including but not limited to: recycled products, remediation, emission reduction products, waste management systems, water management and recycling products and systems.
Including but not limited to: products, processes and services for use in entertainment, tourism, sport & recreation, both for use immediately in these sectors and supporting sectors.
Businesses that undertake food or beverage production, or supply integral services or technologies to support food or beverage production. Businesses that provide integral services, technologies or inputs to support primary production of food and beverages. This definition excludes businesses that are food retailers (including restaurants and cafes) or primary producers, except where they can demonstrate they also substantially undertake the above activities.
Including but not limited to: transport systems (Roadways, rail lines etc.), building and construction, products for the construction and building industry (e.g. new type of air conditioners), processes and services that support construction, building, housing, infrastructure or transport systems.
Developing or producing therapeutic, medical or pharmaceutical products or technologies, including complementary medicines. Providing integral services, technologies or inputs to the development and production of therapeutic, medical or pharmaceutical products or technologies. This definition excludes businesses that are hospitals, medical and other health care services, residential care services, social assistance services and retailers of medical and pharmaceutical goods, except where they can demonstrate they also substantially undertake the above activities.
Mineral exploration, extraction and mining supply chains, including businesses that provide integral services, technologies and equipment for mining and minerals extraction
Engaging in the exploration, development and extraction of energy and fuels from oil, gas, coal and uranium. Businesses that provide integral services, technologies and equipment for use in oil, gas and energy resource sectors.
Products that are manufactured for use in a broad range of products in non-sector specific target markets. E.g. Computer chips, wiring setups
Including but not limited to: clothing, footwear, industrial textiles and related services, processes and products
More information on Growth Sectors marked with a hash (#) is in the Customer Information Guide
Does your product, process or service and/or proposed project involve advanced manufacturing#?
‘Advanced manufacturing’ means adopting innovative technologies or business practices to improve or develop manufactured products, processes or services. This includes the adoption of improvements or innovations across any of a range of manufacturing steps, such as concept, research and development, design, production, logistics, marketing and after-sales services, in order to achieve high value products, services or business outcomes, including improved responses to market demands.

Businesses that supply services, technologies or inputs to the manufacturing processes of businesses described above.

Development

At what stage of development is your novel product, process or service?

Intellectual property

Does the project depend on access to protected Intellectual Property?
Applicants are required to have ownership, access to, or the beneficial use of any IP required for the commercialisation project.
Select the relevant categories for the protected Intellectual Property. *
Describe your IP and its protection strategy

Eligible project

Describe the proposed project that you want grant funding for. List the main expenditure items.

Source of matching funding

Explain how you will fund your share of project costs. For instance, where will you source the funds and what evidence will you provide to demonstrate funds are available?You must be able to demonstrate that you can fund the cost of activities not met by the grant.

Resources to execute plan

Explain how you will fund the commercialisation of your novel product, process or service. For instance, where will you source the funds and what evidence will you provide to demonstrate funds are available? You must be able to demonstrate that you can fund the cost of your proposed plan.

Merit criteria

Accelerating Commercialisation Expression of Interest Form
Fields marked with  * are required
Accelerating Commercialisation applications are assessed on a competitive basis using the merit criteria set out below. Each of these criteria can be addressed by providing evidence against the indicators set out under each criterion. If you progress to the application process you will have an opportunity to provide additional information that you consider relevant to the merit criteria.Please note that responses to merit criteria must be entered in unformatted text. Formatting such as bold text, underlines and dot points cannot be used. Please take care to ensure that your response is written so that it does not depend on formatting to convey information.

Need for funding

Need for Funding must be established for an application for funding to proceed, unless you are a commercialisation office or eligible partner entity.
Explain why you cannot fund the entire project from available financing, including your own resources or borrowings by your company.
Explain why it would be unreasonable to expect that you should obtain financing from existing shareholders, directors, founders or from other investors or lenders. If you proceed to application, you will need to substantiate your case.

Market opportunity

Market Demand: Explain the customer problem you have solved and/or what market demand your novel product, process or service satisfies.
Target Market: Define your target market. Who are your intended customers?
Market Size: What is the size and value of your targeted market? Explain your core assumptions.

Value proposition

Value Proposition: Why does the customer want to buy your novel product, process or service? What are their primary motivations? Describe any existing interest from potential customers.
Evidence of technical functionality: What practical evidence do you have to confirm the functionality and/or technical veracity of your novel product, process or service? For example, do you have a prototype or beta version?

Execution plan

Explain how you will get your product, process or services to market. What are your overall objectives, your tactics to achieve them, and the key challenges you may face. How will you earn revenue from this product, process or service?

Management capability

In relation to the particular stage of your project, what level of expertise do you have in commercialisation management, project management, business management and any relevant sector/technology domain(s)? How do you intend to address any key gaps in your management team?

National benefits

Explain how the project will benefit Australia and/or improve Australia's participation and competitiveness in the global economy? Explain the benefits to the economy beyond the immediate results of the successful project itself, for example, increases in skilled employment, establishing of local manufacturing, improving interactions with research institutions.
Explain the extent to which your project services any of the following Growth Sectors: *Advanced Manufacturing Food and Agribusiness Medical Technologies and Pharmaceuticals Mining Equipment, Technology and Services Oil, Gas and Energy Resources
Refer to the definitions for Growth Sectors marked # in the Target Markets question in the Project Details and Funding tab.

Supporting documents

Accelerating Commercialisation Expression of Interest Form
Fields marked with  * are required

Supporting documents

Any supporting documentation you would like to attach to the application can be uploaded here. The fo