CONFIDENTIAL

Canada/Germany 2015Joint Program
Full Application
DEADLINE: 15th January, 2016 / For internal use
File # :

This form must be filled in with “Arial 11” font, typed at 1.15 line spacing

TITLE OF THE PROJECT (In English)
TITLE OF THE PROJECT (In French)
DELIVERABLES
IDENTIFICATION OF THE PRINCIPAL INVESTIGATOR (PI) (Canada)
Last Name: / First name:
Organization/University:
Department/Faculty:
Address:
City: / Province: / Postal Code:
Country: / Phone #: / Ext:
Email:
IDENTIFICATION OF THE PRINCIPAL INVESTIGATOR (PI) (Germany)
Last Name: / First name:
Organization/University:
Department/Faculty:
Address:
City: / Province: / Postal Code:
Country: / Phone #: / Ext:
Email:
SECTION 1. IDENTIFICATION OF THE RESEARCH GROUP (PIs and CO-INVESTIGATORS).Add lines if necessary
Numeration
(to be used in sections 6 and 12) / Name / Affiliation
(Organization, Country) / Email / Contribution to the project / Academia or private sector / % of the budget allocated to this group / Discipline
1
2
3
4
5
6
7
8
SECTION 2. PROJECT SUMMARY (maximum 1 page)
SECTION 3. SUMMARY FOR LAY AUDIENCE AND PRESS RELEASE (in both English and French, maximum ¼ page each)
(In English)
(In French)
SECTION 4. KEY WORDS (up to 5 words that describe the project, in both English and French)
English
French
SECTION 5. DESCRIPTION OF THE PROJECT (maximum 10pages)
Describe the project by outlining the following aspects of your research:
  • Rationale
  • Background and preliminary results
  • Objectives
  • Research Plan
  • Methodological approach (Include appropriate power analysis for animal and human studies. For human studies, define the recruitment process and elaborate on your ability to recruit the necessary number of patients.)
  • Principal steps
  • Expected results
  • Milestones and go/no go decision points: Milestones are major events or significant steps in a project. Make sure to define your project with a milestone at every 6 months. Each milestone should be accompanied with a specific set of metrics that allows a third party to assess progress. If the project is completely dependent on a specific milestone, address it as a go/no go decision point.
  • For this particular initiative with AIF, the German partners will have a go-no go decision at yr. 1 in order to proceed with the second phase of the project (see details in the call for projects)
  • Deliverables: The deliverables are the concrete, tangible work products. Define clearly the tangible assets that will result from your work and its intended use in the drug R&D process. Additionally, explain how the deliverables may be transferable to and used by the industry in biopharmaceutical research.

SECTION 6. TIMELINES OF THE RESEARCH PROJECT (maximum 1 page)
  1. Insert the principal steps of the project as well as milestones, deliverables and go/no go decision points (as described under section 5) in a Gantt chart.
  2. Identify in the Gantt chart the specific contribution of each PI and co-investigator (by referring to the numbers associated with the investigator as listed in Section 1)at the different steps of the project and specify the cost of each step.

SECTION 7. INNOVATIVE CHARACTER OF THE TECHNOLOGY, POSITIONING AND INTERNATIONAL COMPETITIVENESS OF THE PROJECT (maximum 1.5 pages)
  1. Describe the originality and the innovative character of the proposed research (technology, computational tool or device).
  2. Describe the market targeted by the technology,computational tool or device derived from the research proposal (if applicable).
  3. Identify the most important international competing technologies, computational tools or devices (existing or in development; direct or indirect) that aim to achieve the same goal as your proposed project, by a similar or different technology. Clearly state the names of competing teams in academia and in private organisations.
  4. Position and compare your proposed technology, computational tool or device with respect to the identified competition (at the local and international levels) focusing specifically on the scientific and usability aspects of the technology, computational tool or device and not on the excellence of the team and/or facilities.
  5. Describe the added value of the technology with regard to future potential applications and the international competing technologies used to achieve similar readout or goals.

SECTION 8.IMPACT OF THE PROPOSED RESEARCH(maximum 1.5 page)
  1. Impact on the drug discovery and/or development process:
  • Explain how the generated results/deliverables are expected to impact the drug discovery and/or development process in the near-term following completion of the project;
  • Identify the most important challenges currently faced by the pharmaceutical industry in relation to personalized medicine and describe how your proposed project will address them;
  • Describe how the proposed research will address important challenges in biopharmaceutical research.
  1. Select which main step(s) of the drug discovery and/or development process your project is most likely to impact:
Target identification
/ Discovery / screening
/ Lead optimization
/ Preclinical studies
/ Clinical development

  1. Socio-economic impact of the project (for Canada, Germany).

SECTION 9. DESCRIPTION OF THE RESEARCH TEAM (maximum 2 pages)
  1. Discuss the role of the PIs and co-investigators in the achievement of the research.
  2. Describe their experience and expertise relevant to the proposed research.
  3. Discuss the synergies and complementarities of the team.
  4. If the researchers are affiliated to a private organization:
  • Provide some corporate information;
  • Describe how the organization is qualified in relation to the achievement of the research;
  • Discuss how the proposed research is integrated into the overall corporate objectives of the company.

SECTION 10. LONG TERM DEVELOPMENT PLAN & COMMERCIAL OPPOTUNITIES
The focus of this competition is on innovative technologies or products that can be implemented in pharma or brought to market within the very near term on completion of the 3-year funding period. Please outline how you envision this to occur by detailing the overall anticipated plan, identifying who would perform this, and additionally the time required to implement the plan, as well as its associated costs.
Describe the commercial opportunities that the newly developed technology will open:
  • Outline the commercial opportunities your technology will yield in the biopharma R&D sector.
  • Describe the technical development plan that would be required to commercialise the technology (manufacturing, scale-up, regulation, foreground and background IP, etc.), including a brief tentative timeline.
  • If applicable, briefly discuss how will funding of this project will create synergistic value for your organization and how is the project aligned with corporate goals.

SECTION 11. RISK MANAGEMENT (maximum 1 page)
Describe the potential risks associated with the project as well as their levels of significance. Explain how you intend to manage these risks. The risks may include technical and scientific challenges or may be related to human resources, access to specific material, infrastructure support, IP or other issues.
Please use the following table (add lines if necessary)
Risks / Impact on the project / Probability of occurrence / Risk mitigation
Technological
Human resources
Access to specific material
Infrastructure
Financial
IP
Others
SECTION 12. INTELLECTUAL PROPERTY
12.1 IS THERE ANY PRE-EXISTING INTELLECTUAL PROPERTY (IP) LINKED TO YOUR PROJECT? YesNo
If yes, please answer the following questions (maximum 1 page):
  1. Who are the IP owners?
  2. What is the invention?
  3. Who holds the rights to the IP?
  4. Do the principal investigator and the co-investigators of this project have the legal authorization to use the pre-existing IP?
  5. Are there any commercial relationships or agreements (e.g. licensing agreements) with regards to the pre-existing IP? If so, please describe.

12.2 WILL YOUR PROJECT GENERATE NEW INTELLECTUAL PROPERTY (IP)?YesNo
If yes, please describe (maximum 1 page):
  1. The technology that will result in the creation of the new IP.
  2. Who will be the inventor(s)?
  3. Who will hold the IP rights? Is that person/organization aware of the CQDM licensing policy (described under Section 6 of the guidelines)?
  4. Describe the overall strategy regarding data and IP sharing.

SECTION 13. FINANCIAL ASPECT OF THE PROJECT
Please, report here the first page from the financial table.
13.1 TOTAL FUNDING
Year 1 / Year 2 / Year 3 / Total
Amount requested from CQDM ( in Dollars $)
Amount requested from Germany ( in Euros €)
TOTAL PROJECT (in Dollars $ and in Euros €)
13.2 BUDGET
Year 1 / Year 2 / Year 3 / Total
Canada / Germany / Canada / Germany / Canada / Germany / Canada / Germany
$ / € / $ / € / $ / € / $ / €
ESTIMATED COSTS OF THE PROJECT
Salaries and benefits (research staff, payment to students) (see next section for more detailed salary budgeting)1 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Materials and supplies2 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Travel expenses (conferences, seminars, symposia, fieldwork, collaborations) / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Publication and dissemination costs / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Services3 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Other (please specify)4 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
Overheads (maximum 15%) / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
GRAND TOTAL OF ESTIMATED COSTS / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0
SECTION 14. SIGNATURE OF PIs AND ALL CO-INVESTIGATORS(add pages, if necessary)
Please note that the full proposal must be signed by the PIs and all the co-investigators
1.I authorize CQDM, Germany to exchange all information relating to this application for analysis or evaluation purposes, provided that all persons granted access to this information treat it in the strictest confidence.
2.I understand that the intellectual property resulting from this project will belong to the inventor(s) and their institutions and that a non-exclusive end-user license option will be granted to the CQDM industrial sponsors. The terms of said license option will be negotiated before the beginning of the project no later than 3 months following the confirmation of the funding.
3.I agree that, if this project is retained for funding, I will facilitate the signing of an agreement with respect to the option on the IP generated by this project.
4.I certify that all information provided in this application is complete and accurate to the best of my knowledge.
Signature of the PI (Canada):
Name:
Date:
Signature of the PI (Germany):
Name:
Date:
Signature of the co-investigator:
Name:
Date:
Signature of the co-investigator:
Name:
Date:
RESEARCH ENTITIES SIGNATURE (add pages, if necessary)
1.I certify that I am a signing officer of the research entity representing investigator(s)* ______and that I have the authority to commit the research entity with my sole signature.
2.I read the content of this application and I certify that the information provided in this form is complete and accurate to the best of my knowledge.
3.The research entity supports this application and agrees to provide the functional laboratories or research facilities and the equipment necessary for conducting this research project.
Signature:
Name:
(Print)
Title:
Organization:
Date:
*List the name(s) of the investigator(s) submitting this application who are affiliated to your research entity.

Canada/Germany joint program 2015Page 1 of 16