Application to the Proof of Concept Fund

Research & Innovation Services.

Application to the MRC Confidence in Concept Scheme Round 3 Please refer to the guidance note for this call and adhere to the word count limits to ensure your application is considered by the external review panel.

Project name: Amount requested from the Fund:

1 – Applicant Details Primary Investigator: Department: Extension: Email: Departmental Administrator

2 – ICE/COD Details ICE/COD number: Date ICE/COD submitted: Commercialisation Manager:

3 – Project Details Do not cross-refer to web addresses or add annexes. Project start date: Project end date: In one sentence please state clearly the concept that is to be taken forward during the project

Non- Confidential Summary Please provide a short non-confidential summary of the project – this may be placed on the R&IS website if the application is successful.

General summary of project proposal (maximum250 words) Describe briefly the history, nature, and scope of the project including a brief synopsis of medical need and strategic fit of the work. Distinguish clearly between the previous basic research, which underpins the concept, and the concept that is to be developed in this project to help secure more substantial funding.

Project Plan (maximum 300 words) Present a plan for the proposed project indicating key milestones. What are the objective(s) that will be achieved by the CinC funding? How will these confirm the validity of the concept? MRC Confidence in Concept Application Form Round 3 Jan 2015 1 Immediate Follow on Plan post CinC funding (maximum 200 words) The aim of CinC funding is to provide the data package needed for more substantive translational funding applications. What is the next stage of development after the CinC project and what translational funding schemes (from research councils/ charities/commercial organisations) will you target to fund the next stage? (Please name actual schemes and anticipated application dates).

Translational Path (maximum 100 words) What is (are) the suggested development route(s) to translate the concept towards making a tangible societal impact and addressing the unmet healthcare needs you have identified? Outline possible exploitation route(s) for realising the potential of the concept? Please include details of any discussions with external partners.

Commercial Potential (maximum 200 words) Describe the commercial potential for the concept and how the project will help to achieve this. Describe the gap in the market/technology at which the concept is directed and the economic/social benefit which would accrue upon ultimately successful development of the concept.

Status of the Intellectual Property (IP) underlying the project (maximum 100 words) Is the project novel? Can IP developed in the project be protected? What existing IP or prior art has been identified via searches of patent and publication databases? Please provide details of the search terms used and reference the prior art identified.

University Commercial Assessment System (CAS) status (maximum 100 words) Is this a new opportunity or has it already been part of a previous ICE/COD submission. If the opportunity has been previously assessed in the CAS system please describe what is different about this application or is a new development.

Industrial partners (maximum 100 words) Please detail any partners and their contribution to the project. Are any formal agreements in place?

Other information (maximum 100 words) Is there any other information you would like to provide?

Justification of costs Please provide an outline of the requested funds and describe why these are required to deliver the project and the timescales in which they will be required. Please note that the scheme will not fund capital equipment purchases.

4 – Project costs

Please note: Only direct costs will be funded by a Confidence in Concept project award

Staff costs 2 The award will pay for either: (a) all or a proportion of the salary of the researchers (s) whilst working on the project; or

The decision on which option is the most appropriate rests with the Head of Department. Staff costs will not be paid as personal salary.

(b) Access to equipment, consumables, travel, expenses and other direct costs.

Projects must be costed via URMS using Medical Research Council as the sponsor with a programme name of Confidence in Concept Round 3.

Please note: Applicants are not required to enter Impact costs on their URMS entry for this scheme (see scheme guidance notes).

URMS project code no. Details Amount Staff costs

Travel & subsistence

Consumables

Equipment

Other costs Total Funding requested (Direct Costs only)

5 – Signatures

I confirm that I wish to apply for funding from the Confidence in Concept Scheme. I confirm that the information presented in the application is accurate to the best of my knowledge. Signature of principal investigator:

I confirm that I agree to this application to the MRC Confidence in Concept Fund. Signature of Head of Department:

6 – Return

A signed electronic copy of the application form can be emailed to [email protected] or the original posted to Rachel Dwyer, Research & Innovation Services, New Spring House, 231 Glossop Road, Sheffield S10 2GW. Deadline for receipt 13th April 2015.

MRC Confidence in Concept Application Form Round 3 Jan 2015 3 Applications will not be considered unless signed by the Head of Department.

For RIS Office use only UBASE Project Fund X/00 Authorised Budget £