Application
Take-off phase 1 TO2
Feasibility Study
Project title:
______
The total number of pages of the full document should not exceed 20 pages in total including appendices
For more information see: http://www.stw.nl/takeoff
i
TABLE OF CONTENT
1. Contact details 2
1.1 Main applicant(s) startup 2
Email: 2
1.2 TO2 institution 2
1.3 Summary NWO-domain TTW website 2
1.4 Project summary 2
2. Business idea 3
2.1 Scientific research that lies at the basis of the business idea 3
2.2 The problem 3
2.3 The proposed solution 3
2.4 Innovative aspects 3
2.5 Commercial aspects 3
2.6 The IP position 3
2.7 Business Model Canvas 3
3. The feasibility project plan 3
3.1 The aim of the project 3
3.2 Description of work 3
3.3 Milestones, time schedule and budget plan 3
3.4 The project team 3
3.5 Coaching plan 3
4. Budget plan 4
Personnel costs 4
Investment costs 4
Costs of consumables 4
Travel costs 4
Costs for IP 4
Other costs 5
Total budget plan (milestone based) 5
5. Statement by the applicant 5
5.1 Cluster handling this application 5
Appendices 6
A. Curriculum Vitae team members 6
B. Selection of key publications of the team 6
C. Letters of support 6
D. Proof of agreement 6
C. (optional) Video 6
F. Business model canvas 1
1. Contact details
!Please note: For TO2 applications the main applicant is the start-up.
1.1 Main applicant(s) startup
(The start-up, even when in its formation, requires a KvK number at the moment the full proposal is submitted)
Company name:
Legal entity: (i.e. corporation, LLC, etc.)
Date of establishment:
Kvk number:
Postal address:
Representative:
Name, title(s):
Position:
Gender:
Telephone number:
Email:
Ownership structure:
If applicable, please provide the ownership structure, owners, and share (max. 150 words)
With regards to the transfer of the subsidy, please provide the relevant IBAN details from the
Start-up of the main applicant.
IBAN:
Full name:
1.2 TO2 institution
Please insert below the contact information from your contact at TO2 institution.
Name, title(s):
Position:
Gender:
Telephone number:
Email:
Zero time appointment : yes/no
Institution :
Faculty :
Department :
Postal address :
1.3 Summary NWO-domain TTW website
(Max. 10 lines. Summary in Dutch suitable for publication. Be aware of confidentiality regarding IP, company strategy. Please use this summary also in ISAAC when submitting the application.)
1.4 Project summary
(max half A4)
2. Business idea
(max. 8 pages)
2.1 Scientific research that lies at the basis of the business idea
(please clarify the scientific basis for the idea and what scientific quality of this research is)
2.2 The problem
(please clarify what problem this business idea might solve)
2.3 The proposed solution
2.4 Innovative aspects
2.5 Commercial aspects
(i.e. market analysis, competition, earnings model, etc.)
2.6 The IP position
With regards to IP, if applicable, please provide the following information; 1) title patent,
2) patent owner, 3) patent number, 4) if not published please specify claim.
2.7 Business Model Canvas
(see annex F)
3. The feasibility project plan
(max. 6 pages)
3.1 The aim of the project
3.2 Description of work
3.3 Milestones, time schedule and budget plan
(budget max. 40 k€)
3.4 The project team
(names, affiliation, responsibility, motivation)
3.5 Coaching plan
(describe your training or coaching plan to improve the entrepreneurial skills of your team during this project period, if any)
4. Budget plan
Personnel costs
Employee / Number of hours / Hour rate / This project / Other sources of funding(if any)
€ / € / €
€ / € / €
€ / € / €
SUBTOTAL / € / €
Investment costs
Details / This project / Other sources of funding(if any)
€ / €
€ / €
€ / €
SUBTOTAL / € / €
Costs of consumables
Details / This project / Other sources of funding(if any)
€ / €
€ / €
€ / €
SUBTOTAL / € / €
Travel costs
Details / This project / Other sources of funding(if any)
€ / €
€ / €
€ / €
SUBTOTAL / € / €
Costs for IP
Details / This project / Other sources of funding(if any)
€ / €
€ / €
€ / €
SUBTOTAL / € / €
Other costs
Details / This project / Other sources of funding(if any)
€ / €
€ / €
€ / €
SUBTOTAL / € / €
Total budget plan (milestone based)
This project (max 40k€) / Other sources of funding(if any)
Milestone 1 / € / €
Milestone 2 / € / €
Etc. / € / €
TOTAL / € / €
5. Statement by the applicant
Have you simultaneously requested any additional grants for the execution of the above described business plan either from TTW or from any other organization or financer? / q Noq Yes
(if yes, include details)
Is this request for a Take-off feasibility study phase I a resubmission of an earlier rejected application for a Take-off feasibility study phase I? / q No
q Yes
(if yes, include details)
5.1 Cluster handling this application
(Please note: Please provide you cluster preference. Choose the cluster in which the majority of activities take place. The take-off bureau will make the final decision about where applications are processed.
☐ / Preference for cluster bèta/techniek☐ / Preference for cluster Life Sciences
☐ / Preference for cluster alfa/gamma
By submitting this application through the ISAAC system, I declare that I have completed this form truthfully:
Name:
Place:
Date:
Appendices
A. Curriculum Vitae team members
(max. 2 pages)
B. Selection of key publications of the team
(optional, max. ½ page)
C. Letters of support
(optional)
D. Proof of agreement
An important part of a full proposal is an agreement between the TO2 institution and the start-up. This agreement details what knowledge or IP is transferred to the start-up and how. The agreement must be signed by authorized signatories for both organizations.
Should the proposal be granted both organizations have 8 weeks to sign the agreement and send it to NWO-domain TTW.
The agreement should contain at least:
- What knowledge or IP is transferred;
- Against what conditions does the transfer take place;
- What is the medium of transfer (e.g. license, sale, other);
- Names, titles, roles, and contact information from the signatories for possible verification;
!Please note: the signatory from the TO2 institution may differ from the involved party from the same institution.
C. (optional) Video
A video can be included as part of the application. When doing so, please confer with TTW to discuss whether or not you would like to show the video before the interview with the commission. The maximum duration for the video is 2 minutes.
When making a video please consider the following:
a. An introduction of the applications and team;
b. An introduction of the process, technology or service;
c. What the technology readiness level of the product, process of service is;
d. Why financing is required for succes;
For inspiration, please see the NWO-domain TTW youtube channel or click the following link: https://www.youtube.com/playlist?list=PLKXP4zLipfzt97bLBw6b3xTtCitAbzd4O
!Please note: The video is optional and is under no circumstances a replacement of any of the existing formal requirements in the eligibility check. Whether or not to submit a video is not a criteria in the assessment of the application. If you intend on sending a video please declare your intent by sending a separate email to the secretary of the Take-off program.
Application Take-off phase 1 - Feasibility study 6
F. Business model canvas
Application Take-off phase 1 - Feasibility study 6