Updated Document (June 2016)

German EIT Health Head Start Projects 2016

Application Template

1.  General information

1.1  Project Title*

1.2  Project Acronym*

1.3  Lead Partner:

1.3.1 Name of company/organisation*

1.3.2 Legal Form

1.3.3 Contact details (Name*, postal address, email*, phone)

1.4  Website*

1.5  Complete list of partners/subcontractors involved in the project*

Lead contact / Organization name (Full name and acronym) / CLC/InnoStars / Role of partner

1.6  Project duration* (Please note that the funding will be provided for a maximum of 12 months)

Project start date
Project finish date

1.7  Financial information (Please note that a maximum of 50 K€ will be provided for each project and that the Co-Investment must be at least 50% of the EIT contribution)

Total EIT contribution (in K€)*
+ Co-Investment (in K€)
= Total Costs (in K€)*

1.8  Application or participation in other EIT Health funding schemes

1.9  Declaration of Honor (Please use the form provided by German EIT Health)

2.  Project details

2.1  Short project description* (maximum 1200 characters including spaces)

2.2  Project description (maximum 5000 characters including spaces)

2.2.1  Work plan, milestones and current stage of development of the innovation

2.2.2  Unique selling proposition and commercialization potential

2.2.3  Next step in the valorization pipeline that will be enabled with the EIT Health funding

2.2.4  TRL before and after the project

2.3  Innovative project Outputs and deliverables

Output title / Output description
Deliverable title / Deliverable description

2.4  Incorporation of the company (maximum 1500 characters including spaces)

(Was the company incorporated already? If not, when is the incorporation planned? Please note, that the company has to be incorporated in Germany or Switzerland at the project end at the latest)

3.  EIT Health contribution (maximum 3000 characters including spaces)

(Why are EIT Health’s resources needed for the project? How will the project contribute to EIT Health’s core mission?)

4.  EIT Health’s KPIs addressed (please complete the ones which will be addressed by your project)

EIT Health’s KPIs / No. / Estimated delivery date (MM/YY)
Business ideas incubated
Spin-Offs created
Start-Ups created
SMEs actively involved in EIT Health projects
New or improved products / services/ processes launched
Large industrial partners involved in EIT Health projects
Change in number of employees in KIC supported SMEs
Capital attracted to EIT Health SMEs (in K€)

5.  Impact and next steps (maximum 3000 characters including spaces)

(Expected short term impact of the project, next step towards the market that will be reached by the Head Start funding, next steps after the Head Start grant)

6.  Market (maximum 3000 characters including spaces)

(Market needs, estimated market size, incidence ofdisease, target group of product / service, competitive situation and competitors, market introduction strategy, improvement in market access of the product or service by Head Start funding, time to market (estimated launch year for innovation specified))

7.  Risk analysis (maximum 1500 characters including spaces)

(Market risks, technological risks, commercial risks)

8.  Project Team (maximum 3000 characters including spaces)

(Team / Company description, management structure, number of employees, turnover in 2015, expertise and strengths of the project team) (Please note, that the applicant must be a micro or small enterprise (< 50 employees), spin-off or start-up which has to be incorporated in Germany or Switzerland at the project end at the latest.)

9.  Link to Video Pitch (optional)

10.  Financial Information

10.1  Project budget

COSTS (in K€)
Total EIT contribution
(a) / Co-Investment
(b) / Total Costs (a+b)
Partner 1 (lead)
Partner 2
….
….
Partner n
SUM

10.2  Project budget per Categories

Total Costs (K€) /Categories / Direct personnel costs / Equipment / Infra-structure / Travel / Sub-Contrac-ting / Indirect Costs (up to 25% flatrate) / TOTAL COSTS
Partner 1 (lead)
Partner 2
….
….
Partner n
SUM

10.3  Specification of Co-Investment

Co-Investment 1
Title / reference of Co-Investment
Partner
Description of the Co-Investment
Amount of the Co-Investment
Co-Investment 2
Title / reference of Co-Investment
Partner
Description of the Co-Investment
Amount of the Co-Investment
….
….
Co-Investment n
Title / reference of Co-Investment
Partner
Description of the Co-Investment
Amount of the Co-Investment
SUM of Co-Investment

Please note that the items marked (*) will be made publically available to all EIT Health partners once the project has been selected for funding by EIT Health.

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