R&D Associates Final Report Form 2012-06 Page 1

INDUSTRY ASSOCIATES PROGRAM

ALBERTA INNOVATES
R&D ASSOCIATES
FINAL REPORT

Instructions:
Complete this report form and return to Alberta Innovates Technology Futures (AITF) at least
one week prior to the completion of the funding year. Responses should be as concise and as
detailed as possible.
Answer fields will expand where allowed.
Please return this signed form and report, via fax (780.450.5544) or email
(grants.techfutures@albertainnovates.ca).
Counterpart - This Agreement may be executed in any number of counterparts, and delivered via
electronic transmission in portable document format (PDF), and each such counterpart so executed
and delivered shall be deemed an original and all of which taken together shall constitute one and
the same instrument.
Date: yyyy-mm-dd
SECTION 1: DATA PAGE

Company Name:


r&D Associates Name:

Associates Personal Forwarding Address: During the three years following completion of the grant, AITF may collect
information on impacts and outcomes resulting from the grant funding.

Home Phone: Work Phone: Cell:
Personal Email address: Work Email address:

Company Mailing Address:
Number of employees* in Alberta
FTE PTE

*T4 salaried employees
Total annual sales:

Previous Year: $

Current Year: $
Net income: (Total Sales less cost of
goods sold & operating costs)
Previous Year: $

Current Year: $



R&D Associates Final Report Form 2012-06 Page 2

INDUSTRY ASSOCIATES PROGRAM
ALBERTA INNOVATES
R&D ASSOCIATES
FINAL REPORT


Associates Supervisor Company Title/Position:

Phone: Cell: Email address:

Company Contact (if different from above) Position:

Phone: Cell: Email address:

Signatures Printed Name Date
Associate Signature:

yyyy-mm-dd
Supervisor Signature :

yyyy-mm-dd
Financial/Company Contact Signature:

yyyy-mm-dd



R&D Associates Final Report Form 2012-06 Page 3

INDUSTRY ASSOCIATES PROGRAM
ALBERTA INNOVATES
R&D ASSOCIATES
FINAL REPORT

SECTION 2: TO BE COMPLETED BY THE r&D ASSOCIATE - Future Plans
Indicate the title of your research project during the term of this grant.

a): Provide a non-confidential summary of your research work to date. Include the scope of the research project and any
potentially significant achievements, results or impact of the position.


b) List and describe any new or continuing collaborations (if any) connected with this project.


c) Provide a list of publications and patents (in preparation/submitted/published/presented/issued) produced during the
tenure of this grant.


d) What are your long-term career plans/goals?


e) How did this r&D Associates grant contribute to your career plans/goals?


f) Will you be staying in your position at this company? If not, please give reason(s) and next position if known.


g) If you are leaving the company, will you be staying in Alberta? If not, please give reason(s) and next location if known.

1. Do you anticipate returning to Alberta? If yes, in what capacity? If not, please give reason(s).


2. Do you have plans to continue your collaboration with Alberta? In what capacity?




R&D Associates Final Report Form 2012-06 Page 4

INDUSTRY ASSOCIATES PROGRAM
ALBERTA INNOVATES
R&D ASSOCIATES
FINAL REPORT


SECTION 3: TO BE COMPLETED BY THE COMPANY REPRESENTATIVE Impact/Contributions
a): Has the r&D Associate been hired as a permanent employee? If yes, in what position? If no, provide reasons.


b) Did the company supplement the r&D Associateship? No Yes If yes, by what means?
Financial $ per year Equity value of $ per year (ie. Health benefits/life insurance)

c) Highlight the outcomes of the project work. Indicate types of outcomes such as new or improved products/services,
publications, intellectual property, new customers, new/increased sales, new revenues


d) Describe how the r&D Associates tenure has contributed to innovation and R&D capacity within the Company, and
within Albertas economic sectors. For example, his or her impact on the companys market share, leadership position and
HQP. (highly qualified personnel)


SECTION 4: FINANCIAL ACCOUNTING
PART A: Please provide a written summary of the Research Allowance expenditures for Year Two. Include a detailed
description indicating why the expenditures were made, what they are being used for and how they have contributed to
the research to date. Receipts are not necessary at this time, but may be requested at the discretion of AITF.




R&D Associates Final Report Form 2012-06 Page 5

INDUSTRY ASSOCIATES PROGRAM
ALBERTA INNOVATES
R&D ASSOCIATES
FINAL REPORT


PART B: Provide a breakdown of the Research Allowance expenditures for the funding term just completed in the chart
below. Remember to account for any unused funds carried over from the first term. AITF will reclaim any unused funds
over the total two year Grant.


PART C: Costs Table Provide a financial accounting of how all AITF and company funds were spent for the grant term
just completed using the templates provided. Please note the company will be invoiced for the unused or unapproved
portion of all AITF funds.
Cost Items Year 2 Budgeted Year 2 Actual
r&D Associate (designate) Costs
1. Grants Stipend Contribution $ $
2. Companys salary supplement $ $
3. Companys Fringe Benefits/Equity $ $
Total r&D Associate (designate) Costs $ 0 $ 0
Other Project Costs
1. Capital costs associated with this r&D project $ $
2. Direct materials & supplies costs $ $
3. Operational costs $ $
4. Costs of manufacturing activities associated
with this r&D project $ $
Total Other Project Costs $ 0 $ 0
Research Allowance Expenditures
1. Travel Costs (workshops, conferences, etc.) $ $
2. Equipment Costs $ $
3. Other Qualified Research Allowance Costs $ $
Total Research Allowance Expenditures $ 0 $ 0
GRAND TOTAL OF ALL EXPENDITURES FOR THE
GRANT TERM JUST COMPLETED $ 0 $ 0
Expense Items Year 2 Expense
Amount
$
$
$
$
$
$
$
$
$
$
Total Expenses Year 2 (can include any funds carried over from Year 1) $ 0
Total Expenses Year 1 (from Annual Report) $
GRAND TOTAL $ 0
Over/Under the total of $14,000 during the term of the Grant $ 14,000


R&D Associates Final Report Form 2012-06 Page 6

INDUSTRY ASSOCIATES PROGRAM
ALBERTA INNOVATES
R&D ASSOCIATES
FINAL REPORT


PART D: Source of Support Update Table:
Category Sources Year 2 Budgeted Year 2 Actual
Industry r&D Associates Program
Alberta Innovates
Technology Futures
$ $
Govt funding $ $
Shareholders investments $ $
Angel and/or venture capital investments $ $
Total Cash Sources $ 0 $ 0