Proof of Concept Program Application

Company/Research Institute Information

Organization Name (Company/Academic Research Institute)*

Business Number

Address*

Contact Name/Principal Investigator(s)*

Email*

Telephone Number

# Employees (Not Applicable for Research Institutes)

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 key next steps for the development of your product or technology?
e) Describe the intellectual property plan?
f) For academic research institutes: What is the IP policy of the institute? If institute owned, has the technology been disclosed to the technology transfer office, industry liaison office, or equivalent? If so, provide the name and contact information for the office.
g) 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.
h) 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/Commercialization Strategy*

For companies, address all of the following:
a) Describe the business model, including the value proposition.
b) Describe the path to market, including the production plan.
c) Describe your customers and if applicable describe the market traction.
d) Describe the competition.
e) Describe the regulatory plan.

For academic research institutes, address all of the following:
a) Describe how the product or technology will be commercialized.
b) Describe the potential customers? Indicate if an industry partner has been identified.
c) Describe the competition.
d) 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).

Proof of Concept Trial*

Please address all of the following:
a) Describe the need for the proof of concept (POC) trial.
b) Describe the key growth milestones that will be achieved from conducting the POC trial (eg attract industry partner, licensing opportunity and/or public or private investment; market entry).
c) Provide a summary of the trial(s), key activities, and timeline.
d) List the names and the expertise of the researchers, and research centres conducting the trials.
e) Identify any potential trial-related risks and the mitigation plan to reduce risk.

Trial Budget and Financial Projections*

Please upload the files in Microsoft Word or PDF format: 1) Proof of Concept trial budget 2) For companies: Three-year financial projections

Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 100 MB, Max. files: 4.

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 cost for the Proof of Concept Trial (CAD)*

Requested NPC Contribution (40% of the cost, to a maximum of $350,000 CAD)*

Please enter a number from 100000 to 350000.

List other sources of financial support for the trial (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*

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.

Company/Research Institute Information