Fast-Track to Financing Program Application

Organization Name (Company/Academic Research Institute)*

Business Number

Address*

Contact Name/Principal Investigator(s)*

Email*

Telephone Number

# Employees

Website

Do any of the company's leadership team or Academic Research Institute principal investigator(s) self-identify as one of the four designated groups under the Canadian Human Rights Act: Women, People with Disabilities, Aboriginal Peoples, and Visible Minorities?

Yes

Prefer Not To Answer

If yes, please check all that apply:

Women

People with Disabilities

Aboriginal Peoples

Visible Minorities

Number of employees that self-identify as women and/or black, indigenous or people of colour (BIPOC):

The Organization promotes diversity, equity, and inclusion in the workplace:

Yes

Novel Product or Technology*

Please address all of the following:
a) Describe the problem or need that the product or technology solves.
b) Describe the novel product or technology.
c) Describe the stage of development based on the Technology Readiness Levels (TRL).
d) Describe the intellectual property plan.
e) Describe how your product or technology directly addresses environmental sustainability (i.e reduces petrochemical, eliminates plastics, reduces GHGs, decrease water use, etc). If you have conducted formal audits to measure your environmental impact (such as life cycle analysis or carbon accounting) briefly describe the results.
f) Describe the potential economic, social and/or health benefits of your product or technology.

Market Opportunity*

Describe the market opportunity (size, growth and total addressable market).

Business Model*

Please address all of the following:
a) Describe the business model, including the value proposition.
b) Describe the path to market.
c) Describe your customers.
d) Describe the competition.
e) Describe the regulatory plan.

Team*

For companies: List current management team members, officers, advisors and board members. Briefly describe the roles and background of the management team.
For academic research institutes: Briefly describe the roles and background of the researcher(s).

The Need*

Please address all of the following:
a) Describe the business or commercialization plan support needed.
b) Please explain what you hope to achieve by developing and/or strengthening your business or commercialization plan? (i.e. raise additional private capital, apply for funding programs, etc.)
c) For companies: When do you anticipate raising additional private capital or apply for public funding (>$500,000)?

Expert(s) (External Consultant(s) or other Service Provider(s))*

a) Have you already identified an expert(s)?
b) If you have identified an expert(s), then provide the name of the expert(s) and a summary of the qualifications of the expert(s) as it relates to the business or commercialization support being proposed.

Statement of Work(s)

If you have identified an expert(s), then please upload a copy of the statement of work(s) here in Microsoft Word or PDF format.

Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 100 MB, Max. files: 5.

Are you a member of Canada's Natural Product Innovation Cluster?*

Yes

Project Duration*

One of the eligibility requirements of our programs is to be a member of Canada’s Natural Product Innovation Cluster, a collaborative network of start-ups and SMEs, research institutes, corporations, investors, government and others all focused on naturally-derived products, technologies and services. Once you have completed this application form and submitted it, you will be prompted to join the Cluster.

Estimated Total Project Cost (CAD)*

Requested NPC Contribution (40% of the cost, to a maximum of $25,000 CAD)*

Please enter a number from 0 to 25000.

List other sources of financial support for the project (source and value).

Government stacking rules apply. There is a limit on the combined level of financial assistance from all government sources (federal, provincial, territorial, municipal) not to exceed 75% of eligible costs by SMEs and start-up companies and 100% of eligible costs by academic research institutes.

I certify that the above information is accurate, and that I have the authority to sign on behalf of the company/research institute.

Your Name*

Your Title*

Hidden

Date

Completion Code

Once you have worked with the Natural Products team to ensure that your application is complete, they will give you a Completion Code. Please enter that here.

FAST-TRACK TO FINANCING PROGRAM APPLICATION