Stream 2
Applications under this stream will be reviewed by the Advisory Council. Ensure you meet the definition of a scalable business before applying under this stream.
Please refer to the Commercialization Support for Business Program Guidelines for information regarding the completion of this application.
Save this word doc to your computer, complete it and submit it by email with the required info.
General Information
Name of Applicant:(Legal name and operating name, if different)
Company Address:
(street, city, postal code)
GST/Business Number: (if applicable)
Phone No.:
Fax No.:
Email:
Contact Name and Title:
(Mr., Mrs., or Ms., etc.)
Industry Sector: / Ag Bio
Clean Technology
Information Communications Technology
New Media
Food
Life Sciences
Manufacturing
Service
Other (specify):
Business Structure: / To be incorporated
Federally Incorporated
Provincially incorporated
Partnership
Sole Proprietorship
Cooperative
Other (Specify):
If you are a subsidiary, who is the parent organization?
If your venture is not functioning as a business entity, when do you anticipate it will?
Year of Establishment
Number of Employees: / Full Time: / Part Time: / Contract:
Background
Provide a description of what your business does: (max. 150 words)List the names and provide a brief description of the full time members of your management team. Please identify which members are founders: (max. 200 words)
Without describing your product, describe the opportunity you are addressing in measurable terms. Include such info as market size, market growth rate, and life cycle / industry trends. (max. 500 words)
Describe how your product will be a solution: (max. 300 words)
Describe the intellectual property that you currently own or control:
Please provide a copy of your market validation study complete with third party support:
Included
Please provide a copy of your business plan:
Included
Deliverables:
What are your project deliverables and their timelines for your proposal? Please refer to the program guidelines for examples of outcomes for Stream 2 and identify the outcomes(s) being met by each proposed deliverable.
Request:
List the activities and associated amounts you are seeking support for under this application as they relate to your deliverables. Refer to the program guidelines for ineligible expenditure items.
Economic Benefits:
Outline the economic impacts (in terms of job creation or other benefits to the Manitoba economy) of the proposed venture to Manitoba:
Other Financial Assistance:
Are you currently seeking any other Provincial government funding related to this project?
Yes No
If so, please list the department and name of the program being approached. Provide the name and contact person and amount of funding being applied for.
Are you currently seeking any Federal government funding related to this project?
Yes No
If so, please list the department and name of the program being approached. Provide the name and contact person and amount of funding being applied for.
Financial Review:
Ensure you have included:
Your year to date financial statements and;
One or more of the following documents to support the venture’s ability to pay: company or personal bank statements, letter from a financial institution confirming the amount of available financing, lines of credit, or other forms of financial position.
Declaration:
I hereby apply for financial assistance on behalf of my firm and certify that to the best of my knowledge, the project outlined above will assist in the development or marketing, in a new market, of an innovative product or process.
I will provide, as required, a report on the results of this project to the Department of Growth, Enterprise and Trade agree to participate communications activities relating to this project where appropriate.
I agree to provide the Department of Growth, Enterprise and Trade any additional information that may be required for the assessment of this application.
I also agree and consent to the Department of Growth, Enterprise and Trade obtaining credit and other information from any source for the purpose of reviewing this application and ongoing monitoring should the application receive approval.
The information on this form is being collected in support of an application for financial assistance and will be used solely for this purpose. It is subject to the provisions of Manitoba’s The Freedom of Information and the Protection of Privacy Act (FIPPA) www.gov.mb.ca/chc/fippa and the federal Personal Information Protection and Electronic Documents Act (PIPEDA).
Instructions
· Include all information electronically in this form. This form is intended to be read as a standalone document. If necessary, include additional information as appendices or attachments in your email submission.
· Fill in your information below the instructions. Be sure to include all the headings and information requested.
· Only completed applications will be considered.
· Completed applications with supporting information must be emailed to: .
Updated August 2016