CAIXAIMPULSE 2019 CALL FOR PROPOSALS CAIXAIMPULSE FORM 2019
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CaixaImpulse 2019
Call for proposals
CaixaImpulse Form 2019
In collaboration with: With the support of:CaixaImpulse Form 2019
This Form has only an informative function. Applications will be
submitted using the Application Form on the Programme’s
website (www.caixaimpulse.com). Paper applications or via any
other channel will not be accepted.
“la Caixa” Foundation
In collaboration with: With the support of:General Data
Classification of the application
Select the business area of your project
Therapeutic
Diagnostic
Medical Devices
Select the scientific area of your project
Life Sciences Biomathematics
Cell biology
Human biology
Biochemistry and Molecular biology
Human physiology
Genetics
Immunology
Microbiology
Neurosciences
Medical and Health Clinical sciences
Sciences Epidemiology
Forensic medicine
Occupational medicine
Internal medicine
Nutritional sciences
Pathology
Pharmacodynamics
Pharmacology
Preventive medicine
Psychiatry
Public health
Surgery
Toxicology
Classification of the applicant centre
Select one of the following options
University or university foundation
Research and transfer centre (not university or hospital
related)
Technology centre
Hospital or hospital foundation
Non-profit organisation whose main activity is research
Other
In collaboration with: With the support of:General information about the project
Abstract (proposal summary)
(1500 characters with spaces)
The abstract should provide a brief description of the asset and its market potential,
the value it brings to society and the specific objectives of the valorisation project.
Information regarding the asset to be valued
Protection status
Patent/utility model not filed
Patent pending
Utility model pending
Patent granted
Utility model granted
Estimated time-to-market
Over 6 years
Between 4 and 6 years
Between 2 and 4 years
Less than 2 years
Brief description and level of development of the asset
(1500 characters with spaces)
Description of the technology and its development history. Have experimental concept
tests been carried out? Does an experimental or commercial prototype already exist?
Technology Readiness Level
1
2
3
4
5
6
7
8
9
In collaboration with: With the support of:Project leader and team
Project leader
Project leader’s knowledge and experience in the scientific field of the asset
(1500 characters with spaces)
Describe the project’s leader level of knowledge regarding the asset and/or
technology. Describe the involvement of the project leader in the development of the
asset.
Project leader’s knowledge and experience in the business/management field
Describe the project leader’s level of knowledge in the fields of business management,
technology transfer and innovation management
(1000 characters with spaces)
Project leader’s motivation and commitment
What is the project leader's motivation regarding the valorisation and transfer project?
Could the project leader be interested in continuing his/her involvement in the project
once transferred to the market or for the possible start-up? What are his/her
expectations regarding the programme?
(1000 characters with spaces)
Project team members’ details (if relevant)
Team member 1
Include member
Name and surname
Job title, centre
E-mail
Profile, experience and dedication to the project (500 characters with spaces)
Team member 2
Include member
Name and surname
Job title, centre
E-mail
Profile, experience and dedication to the project (500 characters with spaces)
Team member 3
Include member
Name and surname
Job title, centre
In collaboration with: With the support of:E-mail
Profile, experience and dedication to the project (500 characters with spaces)
Description of the team and the complementarities of the members’ expertise
(max. 1000 characters with spaces)
Only in cases where the participant has support personnel for the development of
the valorisation project. Provide details of the team members, their profile and
previous experience, dedication. If there is a support team, describe the profiles of
the members (particularly if they have a technical, generalist, specialist or business
profile) and their commitment to the project. If any requirements for other profiles to
complement the team have been identified, describe them.
Aims and activities
Project objectives
What are the specific project objectives? What indicators will be used to monitor the
achievement of the objectives? This information allows the correct definition of
objectives (specific, measurable, achievable, result-oriented, time-limited) and their
alignment with the programme objectives
(2000 characters with spaces)
Valorisation actions
Valorisation actions developed and results to date, valorisation actions estimated to be
developed within the programme and indicative cost according to table provided under
"Budget" section
(2500 characters with spaces)
Detail the valorisation actions that have been carried out and their results. Explicitly
state if no valorisation action has been carried out. Estimate the valorisation actions
necessary for the project; describe which are carried out within the programme
framework. This estimated plan and the resources needed to its implementation will
be developed during the first quarter of the programme. The overall approach and
concretization efforts will be rated higher than specific actions. A detailed
valorisation plan, if available, will be included as an attachment in the Documentation
section.
Transformation expectations for society
Identification and description of consequences of transferring the asset to society.
Contribution of the asset to improving people's quality of life, social progress and
human development
In collaboration with: With the support of:(1500 characters with spaces)
Ethical, social, legal and environmental project implications
Describe the possible ethical, social, legal and environmental considerations related to
the project and the transfer to the market: potential military use of the technology, use
of human cells, embryos or human intervention in the research, third countries
implication, and possible impacts on the environment... Describe the ethics committee
in the applicant centre (if existing) and describe the interest and willingness to introduce
the project to it.
(1500 characters with spaces)
Results and indicators
Need or problem to be solved
Description of the reasons behind the development of the asset and whether or not any
of them respond to a social need. Describe the need or problem it addresses and the
value it provides.
(2500 characters with spaces)
Level of innovation
Describe whether the product represents an absolute novelty or if similar products
already exist in the market. In case of the latter, identify and describe the existing
products together with the improvements of the proposed solution compared to the
existing product.
(2500 characters with spaces)
Beneficiaries and clients
Economic and social benefits of the technology. Identification and quantitative
estimation of potential direct and indirect beneficiaries of the solution. Identification of
the client or potential clients. Estimation of the potential market size (national,
international...).
(2500 characters with spaces)
Describe the benefits that the technology will provide from both business and social
points of view: possible applications, economic and social impact, international
impact... In case there is direct social applications indicate what it is and how society
will benefit from the project.
In collaboration with: With the support of:Initial identification and involvement of the different social agents
Which people or groups of people are critical for the success of the project and could
therefore have a positive or negative effect on the transfer to the market? Potential
technological and strategic partners, subject matter experts, beneficiaries, potential
clients...
(1500 characters with spaces)
Based on the knowledge generated from the research, describe the level of
involvement and influence of the different actors in society and their possible
collaboration and participation (researchers, business people, policy makers and
entities and civil society)
Budget
Applicant Other public and
Requested
centre private TOTAL
grant to "la Partner entities
Concept contribution contributions PROJECT Details
Caixa" contributions
Entity COST
Foundation Contribution
name
Materials for
experiments / 0.00 0.00 0.00 0.00
R&D
Outsourcing
of activities for
0.00 0.00 0.00 0.00
R&D
development
New
recruitment of
scientific 0.00 0.00 0.00 0.00
personnel for
the project
Intellectual
property 0.00 0.00 0.00 0.00
protection
Technical /
scientific 0.00 0.00 0.00 0.00
advice
Business
0.00 0.00 0.00 0.00
advice
In collaboration with: With the support of:Applicant Other public and
Requested
centre private TOTAL
grant to "la Partner entities
Concept contribution contributions PROJECT Details
Caixa" contributions
Entity COST
Foundation Contribution
name
Legal advice 0.00 0.00 0.00 0.00
Commercial
and market
0.00 0.00 0.00 0.00
analysis
actions
Regulatory
0.00 0.00 0.00 0.00
development
Production 0.00 0.00 0.00 0.00
Design 0.00 0.00 0.00 0.00
Prototyping 0.00 0.00 0.00 0.00
Travel
expenses
related to 0.00 0.00 0.00 0.00
Valorisation
Plan
Others 0.00 0.00 0.00 0.00
Partnership
Only in case of presentation in partnership with other entities
Please specify the purpose of the collaboration for the partnership projects
(400 characters with spaces)
Please specify what contributions the partner entities will make for the project
(amounts, concepts, etc)
(400 characters with spaces)
What benefits do you expect that the collaboration will have for the project?
(400 characters with spaces)
In collaboration with: With the support of:The amount requested is distributed within the partner members of the Consortium?
Yes
No
In the case that the answer is yes, have you filled in the “Requested Grant to “la
Caixa” Foundation in case of distribution between the members of the Consortium”
template?
Yes
No
Documentation
Complementary documentation for project evaluation
Patent or utility model application (mandatory if patent or utility model are filed).
Related documents and studies (maximum 1 page).
Letters of support or recommendation.
5 most important scientific publications ( advisable).
Prototypes (maximum 1 page).
Valorisation Plan (if available).
Project leader's CV (maximum 1 page) (mandatory).
Transfer Team Representative’s CV (maximum 1 page) (mandatory).
Other Project team members' CVs (mandatory if they exist) (maximum 1 page).
Certification of data validation (available on the application) (mandatory) (Download
template)
Certificate from the Spanish Tax Agency assuring that the applicant centre has fulfilled
its obligations with regard to taxation, valid at the moment of presentation of the project
(mandatory).
In case of a non-Spanish entity, it will be necessary a Declaration of a representative
of the entity assuring that the applicant is in compliance with its local tax obligations
(mandatory).
Social Security certificate in force at the date of presentation of the project. Attach pdf
or jpg. Certificate from the Spanish Social Security assuring that the applicant centre
In collaboration with: With the support of:has fulfilled its obligations with regard to employment, valid at the moment of
presentation of the project (mandatory).
In case of a non-Spanish entity, it will be necessary a Declaration of a representative
of the entity assuring that the applicant is in compliance with its local employment
obligations (mandatory).
Copy of the power of attorney certifying the capacity of the representative to act on
behalf of the Beneficiary (mandatory).
For non-Spanish entities the equivalent documentation according to the legal regime
applying to the entity can be submitted instead-i.e. publications in the Diário da
República (Portugal) or in the Official Journals (rest of countries) (mandatory).
Acceptance Letter duly signed (Download template)
Requested Grant to “la Caixa” Foundation in case of distribution between the members
of the Consortium (Download template)
FBLC reserves the right to ask the applicant for a translation of the documentation into
English if in any case it is required.
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