Application
Take-off phase 1
Feasibility Study
Project title:
_____________
The total number of pages of the full document should not exceed 16 pages in total
For more information see:
http://www.stw.nl/takeoff
i
TABLE OF CONTENT
1.
2.
3.
4.
5.
Contact details and summary
2
1.1
1.2
1.3
2
2
2
Main applicant
Start-up company involved
Summary
Business idea
3
2.1
2.2
2.3
2.4
2.5
2.6
3
3
3
3
3
3
Scientific research that lies at the basis of the business idea
The problem
The proposed solution
Innovative aspects
Commercial aspects
The IP position
The feasibility project plan
3
3.1
3.2
3.3
3.4
3.5
3
3
3
3
3
The aim of the project
Description of work
Milestones, time schedule and budget plan
The project team
Coaching plan
Budget plan
4
Personnel costs
Investment costs
Costs of consumables
Travel costs
Costs for IP
Other costs
Total budget plan (milestone based)
4
4
4
4
4
5
5
Statement by the applicant
5
5.1
5.2
5
5
Application of STW or NWO research results
Cluster handling this application
Appendices
6
A.
B.
C.
6
6
6
Curriculum Vitae team members
Selection of key publications of the team
Letters of support
Application Take-off phase 1 - Feasibility study
1
1.
Contact details
1.1
Main applicant
The main applicant should have a non-zero time appointment at a public research organisation.
(i.e. university, academic medical center, NWO- or KNAW-institute or other institutions as
mentioned in artikel 3.16.1 of the Regeling Nationale EZ-subsidies)
Name, title(s):
Position:
Gender:
Telephone number:
Email:
Zero time appointment :
yes/no
Institution :
Faculty :
Department :
Postal address :
1.2
Start-up company involved
Start-up company (optional)
Company name:
Legal entity:
Date of establishment:
Kvk nr:
Postal address:
(i.e. BV, eenmanszaak, etc.)
Representative:
Name, title(s):
Position:
Gender:
Telephone number:
Email:
1.3
Summary
(Max. 5 lines. Summary in Dutch suitable for publication. Be aware of confidentiality regarding
IP, company strategy. Please use this summary also in ISAAC when submitting the application.)
Application Take-off phase 1 - Feasibility study
2
2.
Business idea
(max. 8 pages)
2.1
Scientific research that lies at the basis of the business idea
(make clear what is the scientific basis for this idea and what is scientific quality of this research)
2.2
The problem
(make clear what problem this business idea might solve)
2.3
The proposed solution
2.4
Innovative aspects
2.5
Commercial aspects
(i.e. market analysis, competition, earnings model, etc.)
2.6
3.
The IP position
The feasibility project plan
(max. 6 pages)
3.1
The aim of the project
3.2
Description of work
3.3
Milestones, time schedule and budget plan
(budget max. 40 k€)
3.4
The project team
(names, affiliation, responsibility, motivation)
3.5
Coaching plan
(describe your training or coaching plan to improve the entrepreneurial skills of your team during
this project period)
Application Take-off phase 1 - Feasibility study
3
4.
Budget plan
Personnel costs
Employee
Number
of
hours
Hour
rate
€
€
€
SUBTOTAL
Other
sources of
funding
(if any)
This project
€
€
€
€
€
€
€
€
Investment costs
Details
This project
SUBTOTAL
€
€
€
€
Other sources
of funding
(if any)
€
€
€
€
Costs of consumables
Details
This project
SUBTOTAL
€
€
€
€
Other sources
of funding
(if any)
€
€
€
€
Travel costs
Details
This project
SUBTOTAL
€
€
€
€
Other sources
of funding
(if any)
€
€
€
€
Costs for IP
Details
This project
SUBTOTAL
Application Take-off phase 1 - Feasibility study
€
€
€
€
Other sources
of funding
(if any)
€
€
€
€
4
Other costs
Details
This project
SUBTOTAL
€
€
€
€
Other sources
of funding
(if any)
€
€
€
€
Total budget plan (milestone based)
This project
(max 40k€)
Milestone 1
Milestone 2
Etc.
TOTAL
5.
€
€
€
€
Other sources
of funding
(if any)
€
€
€
€
Statement by the applicant
Have you simultaneously requested any additional grants for
the execution of the above described business plan either
from STW or from any other organization or financer?
 No
 Yes
Is this request for a Take-off feasibility study phase I a
resubmission of an earlier rejected application for a Take-off
feasibility study phase I?
 No
 Yes
5.1
(if yes, include details)
(if yes, include details)
Application of STW or NWO research results
(If applicable, include project number and other details)
5.2
Cluster handling this application
(Note: STW decides in which cluster your applicationis handled)
 Preference for cluster bèta/techniek
 Preference for cluster Life Sciences
 Preference for cluster alfa/gamma
By submitting this application through the STW-ISAAC system, I declare that I have
completed this form truthfully:
Name:
Place:
Date:
Application Take-off phase 1 - Feasibility study
5
Appendices
A.
Curriculum Vitae team members
(max. 2 pages)
B.
Selection of key publications of the team
(optional, max. ½ page)
C.
Letters of support
(optional)
Application Take-off phase 1 - Feasibility study
6