2017 Letter of Intent Form 2017 Letter of Intent (LOI) Form Project Overview Project Title: * What problems or challenges does this project aim to address? Please include key deliverables and objectives. Project Lead: Salutation * Dr. Ms. Mrs. Mr. First Name: * Last Name: * Email Address * Project Lead Organization / Company Information: Organization: * Department: Phone Number: * Website/URL Mailing Address: * Project Cost Summary for 2017: Total Project Duration: * Estimated Total Project Cost (all years): * 2017 Project Year Cost: Please note that projects are approved on a a per year basis. Should the project receive funding the proponent will need to re-apply for the next year of funding. 2017 AUPRF Funding Request: Has this project previously received AUPRF Funding? Yes No Leveraged Funding: If more detail is required then please note that you can upload additional funding information at the bottom of this form. Please indicate below if funding is Requested / Secured / In-kind. Funding Source Requested / Secured / In-kind Funding Source Requested / Secured / In-kind Funding Source Requested / Secured / In-kind Total Leveraged Funding Executive Summary: Project Benefits: Describe how industry and others will benefit from this project. What is the anticipated impact? (i.e. cost reductions, improved environmental performance, impact on regulation, enhanced access to resources) (<250 words). Technical Area your proposal addresses: * Air Quality and Climate Change Soil and Groundwater Ecological Water Well Abandonment Please copy and paste the policy issues/knowledge gaps that your project is addressing from the link into the box below: Air Quality and Climate Change Soil and Groundwater Ecological Water Well Abandonment What policy issue(s) / knowledge gap(s) is your project addressing? File Upload Drop a file here or click to upload Choose File Maximum file size: 516MB If you wish to include any documents to support your application you can upload here.