Notice to the applicant: This document must be read and completed in conjunction with the Announcement of Opportunity (AO). Please read it in full before completing this application form. In case of contradiction or discrepancy, this document takes precedence. Your application may not be considered if it is incomplete. If required, please communicate with the contact mentioned in the AO. Once this form has been completed, please send it with the other required documents (according to the method provided for in the AO). It is to be noted that email communication may not meet the Government of Canada's data protection requirements.

The information provided will be treated in accordance with the Access to Information Act and the Privacy Act.

SECTION 1 – APPLICANT INFORMATION
Legal name of the organization as per the incorporation or registration documents (see section 11).
Tick the applicable box (select only one topic): Category 1: Data and Sample Mining (DM) Category 2: Research Models (RM)
Type of organization: ☐ Canadian university or post-secondary institution ☐ Not-for-profit organization established and operating in Canada
Full name of Canadian Principal Investigator (PI)	Full name of the duly authorized representative for the organization (person who can legally bind the entity organization by approving documents such as agreements, contracts, etc.):
Title/Position	Title/Position
Address	Address
Telephone	Fax	Telephone	Fax
Email	Email
Preferred language for correspondence

SECTION 2 – APPLICATION SUMMARY
Project title:
Amount requested from the CSA per government fiscal year (April 1 to March 31) Up to one year for Category 1 (DM) Up to two years for Category 2 (RM)	Total Project Budget (CSA + Other funding sources, if applicable)
FY 1 (April 1 2027 – March 31 2028)	FY 2 (April 1 2028 – March 31 2029)	CSA Total
Please summarize the project (maximum of 150 words) using non-technical terms suitable for public dissemination. This summary will be used for public disclosure and announcements if your proposal is selected.
Please describe the project using keywords (maximum of 10) separated by semicolons.
Total project costs:	Estimated Start Date (yyyy-mm-dd): Estimated End Date (yyyy-mm-dd):

SECTION 3 – TEAM MEMBERS (PRINCIPAL INVESTIGATOR AND CO-INVESTIGATORS)
Please provide the names and contact information of the team members. Please attach the curriculum vitae (CV) or generic version of the Common CV (CCV) for each member of the team. Attach an additional sheet if needed. State the role and explain the responsibilities of each person involved in the proposed research project.
Team Member 1 (Applicant)
Full Name	Telephone
Title/Position	Email
Organization	Role in project
Responsibilities in the project
Team Member 2
Full Name	Telephone
Title/Position	Email
Organization	Role in the project
Responsibilities in the project
Team Member 3
Full Name	Telephone
Title/Position	Email
Organization	Role in the project
Responsibilities in the project
Team Member 4
Full Name	Telephone
Title/Position	Email
Organization	Role in the project
Responsibilities in the project
Team Member 5
Full Name	Telephone
Title/Position	Email
Organization	Role in the project
Responsibilities in the project
Team Member 6
Full Name	Telephone
Title/Position	Email
Organization	Role in the project
Responsibilities in the project

SECTION 4 – EVALUATION CRITERIA
The complete grid of evaluation criteria is detailed in Section 5 of the AO. Applicants are required to respond to the items listed below by describing and justifying how the proposal meets the criterion. **IMPORTANT: This form will be the only source of information considered by reviewers to evaluate the proposal for evaluation criteria in Section 5 (Eligibility and Graded evaluation criteria). Applications that fail to meet one or more criteria will be deemed non-compliant and will not be assessed further.
Eligibility Criteria
1. For Category 1 - Data and sample mining (Section 1 of the AO) Proof of access to the required data or samples (if applicable) – maximum of 300 words
2. Eligible recipients (Section 3.1 of the AO) - maximum of 300 words
3. Eligible projects (Section 3.2 of the AO) - maximum of 300 words
4. Links to CSA Priorities (Section 3.3 of the AO) – maximum of 500 words
5. Links to G&C Program Objectives (Section 3.4 of the AO) - maximum of 300 words
6. Meets program funding provisions (Section 6.1 of the AO) - maximum of 300 words
Graded Evaluation Criteria (Section 5.2 of the AO)
Benefits to Canada
Alignment with the priorities of the CSA and its Space Health & Life Sciences Program. Demonstrate that the proposed research objectives are aligned with the priorities of the CSA and its Space Health & Life science program (section 3.3). - maximum of 300 words
Link to future space studies. Demonstrate that the proposed research objectives are direct precursors of future Canadian research projects on the ISS or the lunar Gateway, and that the research will generate strategies for novel countermeasures against the risks of human space flight. maximum of 300 words
Benefits on Earth: describe how the proposed research will contribute to the advancement of understanding of similar health issues or applications on Earth, or to the improvement of health care for Canadians. - maximum of 500 words
Equity, diversity, and inclusion (EDI): describe the specific means that will be taken to foster recruitment and engagement of members from underrepresented groups within the research team. - maximum of 300 words
2. Project Feasibility, Resources and Risk Assessment
Budget, Resource Allocation and Schedule Attach a detailed schedule for the project. This schedule must show the various phases of the project, their duration (including estimated start and end date), the personnel requirements and their task assignments, and the level of effort associated with each of the tasks (description), as well as the number of publications expected. If additional space is required, please attach a document named: SCHEDULE (do not refer to proposal). Provide the number of Canadian HQPs (employees or students who have a BSc degree), undergraduate students, and employees without a BSc involved in the project per year, and total for the duration of the project. Number of Canadian HQPs and students Year 1 Year 2 Total for the duration of the project (count personnel only once) Undergraduate students (BSc) Graduate students (MSc) Graduate students (PhD) Postdoctoral fellows (PDF) Research personnel with BSc Research personnel without BSc Total Also provide a detailed itemized budget, according to the following eligible CSA budget categories. Under the “Description and Details” column, applicants are required to explain/justify the nature of expenses to allow reviewers to evaluate adequacy of budget allocation. If the table below doesn’t provide enough space, applicants can attach separate document named: BUDGET (do not refer to proposal). Applicants are encouraged to seek co-funding and should include other source of funding in their budget. Co-funding can occur in a number of ways, including institutional support of students through scholarships. Eligible Cost means any Project cost listed below that is essential to carry out the Project, reasonable and directly related to the Project. The total amount and the breakdown by source of funding must be provided for each category of cost. All amounts must be in Canadian dollars and NET of all discounts and tax reimbursements. The costs are to be incurred directly by the applicant. Incurred Costs means any expense made to carry out the Project related to an Eligible Cost which is due and payable. CSA will not contribute to costs Incurred prior to the coming into force of a Funding Agreement and after the Project Completion Date. IMPORTANT NOTE: For the DM and RM AO, grant funding applies as follows: For Category 1 (DM): Maximum amount of 75,000$ for up to one year; For Category 2 (RM): Maximum amount of 180,000$ for up to two years. The total maximum amount requested must include overhead costs. Budget Breakdown ($) Eligible cost - categories Description and Details Amount of funding requested from the CSA by Fiscal Year (April 1 to March 31) Other levels of government funding (federal, provincial, territorial, municipal) –Section 8 Other Sources Including Funding from your organization –Section 8 Total Budget : CSA + Other FY 1 (2027-2028) FY 2 (2028-2029) CSA TOTAL Accommodation and meal allowances Acquisition, development and printing of materials Acquisition or rental of equipment Bursaries (such as stipends for students involved in the project) Consultant services Costs related to obtaining security clearance Data acquisition (sample acquisition) Data management Laboratory analysis services 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 or reimbursement to which the recipient is entitled Publication and communication services (detail the number of publications expected) Registration fees Salaries and benefits Training Translation services Travel Other expenses (cannot be funded by the CSA) Sub-Totals before overhead Overhead (administrative) costs (Universities & post-secondary institutions: max of 20% of eligible costs; other eligible recipients: 15% of eligible costs). TOTAL PROJECT COSTS: Total requested to CSA:
Risk Management and Mitigation strategies List and describe potential risks to the project (financial, technical, and managerial) and present risk management and mitigation strategies in the table below or in a document attached to your submission. The proposal evaluation will assess the knowledge of potential pitfalls and obstacles that may occur during project course and adequacy of proposed preventive/remedial measures. Extra rows in the table can be added to list additional risks. If some of the risks do not apply, indicate N/A. # Risks Likelihood (rare, possible, high) Impact Mitigation/Preventative action Managerial 1 Inability to recruit qualified undergraduate/graduate students 2 Unavailability/loss of key team members/students 3 (Other managerial risks) 4 Financial 5 Budget is exceeded or insufficient 6 Inability of students to obtain scholarship 7 (Other financial risks) 8 Technical 9 Issues with optimizing experimental protocols and endpoints 10 Equipment failure 11 Sample/subject loss; corrupted data set 12 (Other specific technical risks) 13 14
3. Evaluation Criteria for Scientific Merit Review (see Section 5.2.2 of the AO and Annex 3) Applicants will be evaluated according to the criteria stated in Section 5.2.2 (Table 4) of the AO and described in detail in Annex 3 of the AO.

5. Detailed Project Description
Please attach a 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. The description should be around 2500 words in a MS Word format (.DOC, .DOCX), 12pt typeface, lettersized paper and 1" margins. The cover page of the attachment must contain the title of the proposal, the name of the investigator and the legal name of the organization requesting the grant.
Ethical requirements	This section is reserved for CSA use only.
Applicant needs to ensure that institutional ethical certification requirements have been met and a letter signed by the chairperson of the local Research Ethics Board (REB) or Animal Care Committee (ACC) regarding approval of the experimental protocol will be required for funding.	Result of review

SECTION 6 – DATA MANAGEMENT PLAN
Please provide a Data Management Plan addressing the following items: Types of data products; Short term data preservation approach; Long term data preservation/archiving approach; Formats for data and metadata; Sharing and Reuse of the data, when applicable; Roles and Responsibilities for data management within the team.

SECTION 7 – RE-APPLICATION
For applicants resubmitting a previously unsuccessful application for a CSA competition, they should provide a response to previous reviewers’ comments that are relevant to the revised application. Please include all the reviews received from the previous competition in the response. Maximum length is 2 pages, not including the reviews from previous competition.

SECTION 8 – OTHER SOURCES OF FUNDING FOR THIS PROJECT
Please identify all sources of funding for your project, including CSA, Governmental Assistance*, other source and your organization. * Governmental Assistance means all financial and non-financial assistance from federal, provincial, territorial, and municipal governments allocated to the Project, including but not limited to grants, contributions, reduced interest loans or forgivable loans, donations, sponsorships, Research and Experimental Development (SR&ED) investment tax credit and all financial assistance for a similar project by an entity with which it has a non-arm’s length relationship. In-kind contributions are not considered sources of funding. The funding amount should be expected to be received directly by the applicant. Please complete the budget table below. Fiscal Year April 1st – March 31st Sources of funding (in Canadian dollars) Amount of funding requested from CSA Other levels of government (federal, provincial/ territorial, municipal) Other Sources including funding from your organization Total Budget (CSA + Other) Name of funding organization and its funding program Contact Person (Full Name, Title, Telephone number, Email) Type of Fund (grant, contribution, loan, scientific research and experimental development (SR&ED) tax incentives, etc.) Application Status (confirmed/ pending) Funding Amount ($) 202x-202x 202x-202x 202x-202x Total 100%

SECTION 9 – SUGGESTED REVIEWERS
Please identify at least four Canadian reviewers with the relevant expertise for this proposal. Please consider including a woman as a reviewer in your suggestions.
Full Name	Organization	Telephone	Email

SECTION 10 – OTHER
Please provide other documents to support your proposal (e.g. letters of support from each coinvestigator listed and letters of intent from organizations providing other sources of funding or inkind contributions).

SECTION 11 – REQUIRED DOCUMENTATION AND SUBMISSION CHECKLIST
Below is a check list to ensure that all required documents and information has been provided for a complete submission package. Applicants are required to hand-fill the following list, checking and initialling each item to confirm inclusion in the package. Please note that incomplete or late applications will not be considered for funding. Please note additional documents may be requested at a later step of the Evaluation Process.
Items	Initials	Items
A completed original application form signed by the duly authorized representative (digital signature is required);
A copy of the document(s) confirming the legal name of the applicant (proof of incorporation or registration);
For Not- for- profit organizations, an original or certified copy of their certificate of constitution, letters patent, or other constitutive documents. Non-original or uncertified copies are accepted for the purposes of the application, but subsequently the original document will be required at the time of the signing of the agreement;
Letters from other funding contributors confirming their contributions, if applicable.
Letter of support from Co-Investigators, confirming their intent to participate to the study, including information on the potential source of funds, if applicable;
For Category 1 (DM), letters from providers of any other data or samples that are not openly accessible confirming the availability of the data or samples, if applicable;
Applicant needs to ensure that institutional ethical certification requirements have been met and a letter signed by the chairperson of the local Research Ethics Board (REB) or Animal Care Committee (ACC) regarding approval of the experimental protocol will be required for funding;
A Data Management Plan shall be provided with the proposal, and it shall address: types of data products, short term data preservation approach, long term data preservation/archiving approach, formats for data and metadata, sharing and reuse of the data, when applicable; and roles and Responsibilities for data management within the team;
Declaration on Confidentiality, Access to Information Act and Privacy Act form signed by the duly authorized representative;

SECTION 12 - Lobbying Act R.S.C (1985) of Canada
Lobbyists and their clients are subject to the Lobbying Act, R.S.S 1985, c. 44 (4Th supplement). ☐ I declare that I have not requested the services of a lobbyist within the meaning of the Lobbying Act as part of my application. ☐ I declare that I have requested the services of a lobbyist within the meaning of the Lobbing Act as part of my application and declare that any person lobbying on my behalf is in compliance with the provisions of the Lobbying Act. Name of lobbyist: _________________________________________________ ☐ I declare that the lobbyist does not receive any payment that depends, in whole or in part, on the result obtained in connection with this application.

SECTION 13-A – APPLICABLE ONLY TO ORGANIZATIONS COVERED BY THE Act respecting the ministère du Conseil exécutif (R.S.Q., ch M-30), CHAPTER M-30, STATUTES OF QUEBEC
The organizations referred to in Article 3.6.2 (SECTION 13-B) are required to obtain authorization prior to signing a funding agreement with the federal government or with a federal public agency such as the Canadian Space Agency (CSA).
Please review the relevant provisions of the Act and answer the three questions below. In the event of a discrepancy between the Law and the reproduction of the provisions below, the text of the Law applies.	YES	NO
1) In connection with section 3.11, is the applicant a municipal body or a school body within the meaning of section 3.6.2 of the Act?
2) In relation to section 3.12, is the applicant a public agency within the meaning of section 3.6.2 of the Act?
3) In connection with article 3.12.1, if a funding agreement were to be signed between the applicant and the CSA, will this agreement affect a Quebec government agency, a municipal body, a school body, or a public agency within the meaning of section 3.6.2 of the Act?
If you answered “YES” to one (1) of the three questions: Do you have prior authorization (e.g., exclusion order) from the Government of Quebec to enter into a funding agreement with the Canadian Space Agency? If “yes”, please specify: ______________________________________ If “no”, please refer to the website of the Quebec Secretariat for Canadian Relations to find out what steps to take to obtain a written authorization to enter into a funding agreement with the Canadian Space Agency.
If you answered “NO” to all 3 questions, the CSA may request additional documents or information.

SECTION 13-B – PROVINCIAL PRIORITIES ACT (C. P-35.5) AND PROVINCIAL PRIORITIES REGULATION (ALTA REG 21/2025)
Does the Applicant operate in Alberta? ☐ YES ☐ NO
If you answered « NO », you can proceed to section 9 of the form. If you answered « YES », please review the relevant provisions of the Act and its regulation and answer the following questions:
Is the applicant a provincial entity within the meaning of the Act and Regulation? ☐ YES ☐ NO
If you answered « YES » to question above: Undertake and confirm that the Applicant will comply with the Provincial Priorities Act P-35.5 (the Act) and its Regulation and, if applicable, that the Applicant will obtain prior approval from the Government of Alberta to enter into a funding agreement with the CSA. ☐ I confirm If applicable, we invite you to contact your responsible Minister to find out what steps must be taken to obtain the required written authorization to enter into a funding agreement with the CSA. The CSA may ask you to complete documents related to the application of the Act and its Regulation. The CSA may, at its sole discretion, request additional documents and information.

SECTION 13-C – DEFINITIONS (Article 3.6.2 – excerpts)
Municipal body means …
(1) a municipality; (2) a metropolitan community; (3) a legal person or body that has one of the following characteristics: (a) a majority of its members are appointed by one or more municipal bodies; (b) more than half of its financing is provided by one or more municipal bodies; (4) a group of municipal bodies.
School body means …
(0.1) a school service centre; (1) a school board; (2) the Comité de gestion de la taxe scolaire de l’île de Montréal; (3) a legal person or body that has one of the following characteristics:(a) a majority of its members are appointed by one or more school bodies;(b) more than half of its financing is provided by one or more school bodies; (4) a group of school bodies.
Public agency means …
(1) a legal person or agency that, although not a government agency, a municipal body, or a school body, has one of the following characteristics:(a) a majority of its members come from the Québec public sector, that is, are appointed by the Government, a minister, a government agency, a municipal body, a school body or another public agency;(b) its personnel is appointed in accordance with the Public Service Act (chapter F-3.1.1);(c) more than half of its financing is derived from Québec public funds, that is from the Consolidated Revenue Fund, a government agency, a municipal body, a school body or another public agency; (2) a group of public agencies.
Government agency means …
A legal person or agency that, under its constituting Act, is empowered to make inquiries, issue permits or licences, or make regulations for purposes other than its internal management and, if it is a legal person, has one of the following characteristics: (1) it is the mandatary or agent of the State or of another government in Canada; (2) it enjoys the rights and privileges of a mandatary or agent referred to in paragraph 1.

SECTION 14 – LEGAL CONSIDERATIONS Please answer the following 5 questions.
Does the Applicant have any claims/debts owed to any federal, provincial, municipal or territorial government or has it received an overdue claim from such an organization? ☐ NO ☐ YES. Please complete the following table: Government (specify) Amount Due date (yyyy-mm-dd) The Agency may, at its sole discretion, request additional documents and information. On the date of filing of this application or within the past two years, the Applicant has made an assignment of its property, is or was placed in receivership under the Bankruptcy and Insolvency Act, or any similar legislation? ☐ NO ☐ YES The Agency may, at its sole discretion, request additional documents and information. On the date of filing of this application or within the last two years, the Applicant has committed an act of bankruptcy, filed a notice of intention or proposal under the Bankruptcy and Insolvency Act, and/or is subject to procedures in accordance with the Companies’ Creditors Arrangement Act or any other similar legislation; ☐ NO ☐ YES The Agency may, at its sole discretion, request additional documents and information. On the date of filing of this application, has the Applicant received a formal or informal notice indicating that it could be, or is, in violation of an environmental law or regulation? ☐ NO ☐ YES. Please forward to the Agency a copy of the notice received. The Agency may, at its sole discretion, request additional documents and information. Does the Applicant have legal proceedings pending before the courts? ☐ NO ☐ YES The Agency may, at its sole discretion, request additional documents and information.

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

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

The CSA manages and protects information provided by the applicant in accordance with the Privacy Act and Access to Information Act. More details about the handling of your personal information is described in the personal information document related to Grant and Contribution Program to Support Research, Awareness, and Learning – Research Component (ASC PPU 045) and Awareness and Learning Component (ASC PPU 040). This information will be used for administration and application evaluation purposes. Personal information (such as name, contact information and biographical information) will be kept for 6 years and then destroyed. According to the Privacy Act, any individual may upon request, (1) have access to his or her personal data and (2) request correction of incorrect information.

Applicants must ensure any collection of personal information complies with all federal, provincial/territorial legislation and municipal bylaws.

For additional information regarding this statement, please contact:

Office of Access to Information and Privacy

Canadian Space Agency

Email: aiprp-atip@asc-csa.gc.ca

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)

APPLICANT ATTESTATION

By submitting this proposal, the Applicant, through its duly authorized representative signing below:

1. Agrees with the terms herein and contained in the AO and certifies that it has all the resources and capacities necessary to carry out the project.

2. Understands and certifies that the information provided in the context of this application will be treated in accordance with the Access to Information Act and the Privacy Act.

3. Understands and accepts that CSA has no obligation to provide funding to the Applicant. The CSA is not responsible for any costs and expenses incurred or paid by the Applicant prior to the execution of a funding agreement between the CSA and the Applicant.

4. Understands and accepts that the execution of a funding agreement with the Agency is conditional, among other things, upon its proposal being accepted by the CSA and upon confirmation to the CSA’s satisfaction of the sources of funding pertaining to the proposal.

5. Understands and accepts that the CSA reserves its right, at its sole discretion, to modify or cancel the Announcement of Opportunity (AOP) process.

6. Certifies and confirms that no member of the House of Commons or the Senate will be a party to the funding agreement that may result from this proposal or shall be entitled to benefit from it or to receive any benefit to which the general public is not entitled

7. Certifies that it has disclosed, and will disclose if applicable, all sources of funding pertaining to the project including any government assistance or financial assistance requested or received for the project, as well as any other government assistance or financial assistance requested or received for a similar project by an organization or entity with which the Applicant has a non-arm's length relationship within the meaning of section 251 of the Income Tax Act (R.S.C. (1985), c 1 (5th Sup).

8. Certifies that no former holder of public office of the Government of Canada or public servant to whom applies the Conflict of Interest Act, the Values and Ethics Code for the Public Service, or any other law, regulation, code, policy, procedure or directive of an equivalent nature, derives or shall derive a direct or indirect benefit from a possible funding agreement with the CSA, or that if such a person derives a benefit from it, he or she does so and will do so in accordance with the laws and codes mentioned above.

9. Undertakes to provide the CSA, without costs and, delay and in the form requested, with all the information necessary to complete the evaluation of the request for financial assistance and, if applicable, to execute and enforce a possible financing agreement.

10. Understands and certifies that all information relating to this application and the funding agreement that may result from this application for financial assistance, may be publicly disclosed under the laws, policies, and directives of the Government of Canada.

11. Certifies that the information provided in the context of this form and all the documents submitted are complete, true and accurate.

The person signing below certifies that it has the authority to submit this application on behalf of the Applicant.

I am the duly authorized representative of the Applicant and, as such, I confirm that I have the authority to submit this application on behalf of the Applicant and that by submitting this form I bind the Applicant as if my original signature were affixed to it.

Signature:	Date (yyyy mm dd):
Duly authorized representative (type name and title)