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.

In collaboration with:                                                 With the support of:
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