Application Form TBM
Application Form
TBM programme
Version October 2012
First Read ‘Handleiding TBM’!
(see http://www.iwt.be/subsidies/documenten)
Application Form TBM
Layout and compilation of a project proposal
The main applicant appoints a project leader who is responsible for the submission of the project proposal
and the management of the project.
It is recommended to read the document “TBM Handleiding” before filling in the application form! See
http://www.iwt.be/subsidies/tbm/documenten.
This application form should be considered as an aid for the compilation of the project proposal. The use of
the template is not obligatory, but the structure, the order of the chapters and page limits should be
respected.
The modalities for submission (address, date and number of copies) are described in the document “TBM
Oproepdocument”.
The project proposal has to be written in English!
In the final project application the text in italics should be deleted throughout the entire proposal!
Checklist with the different parts of the project proposal. The applicants need to submit an electronic version
of the complete project proposal by e-mail or CD-rom. The title of the electronic document must be the
same as the title of the project proposal.
 Part 1: Project identification
 Project summary
 Administrative data main applicant
 Administrative data co-applicant(s)
 Part 2: Project description
 Fit of the project in the TBM programme
 Rationale, state of the art and innovation goal
 Utilisation of the project results
 Approach and work programme
 Expertise/track record of the applicant(s)
 Part 3: Project budget
 Project budget for each applicant
 Total project budget
 Part 4: Enclosure(s)
 Signed declaration of intent (“intentieverklaring”) applicants
 Signed declaration (“verklaring”) project leader
 Approval ethical committee(s) (if relevant)
 Quote(s) for subcontractors (if relevant)
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Part 1: Project identification
In each part is indicated who is best placed to fill in the data. The main applicant assembles all data.
A. Project summary
This part should be filled in by the main applicant.
Title
Planned start date of the project
Duration of the project
Total budget of the project
Within 6 months after the decision by the Board of Directors
of IWT, the earliest the first day of the month after
submission (for project proposals that can be declared eligible
within the normal timeframe). If the project starts before the
decision of the Board of Directors, this is at risk of the
applicant.
Minimum 24 months and maximum 48 months
Minimum € 250.000 and maximum € 1.000.000
Total manpower (number of man months)
Did you apply for subsidy or did you receive subsidy for this project or parts of this project through
the government (Flemish, Federal or European)?
If you did, through which channel?
If you did, what is the amount of the
requested or granted budget?
Summary:
In this section (ca 1 pg) a summary is given of:
1) the scientific objectives and the scientific approach,
2) the utilisation objectives and the utilisation potential, in terms of improvements in the
(Flemish) health situation,
3) the proposed utilisation strategy in order to achieve the improvement in the (Flemish)
health situation.
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B. Administrative Data Main Applicant
This part should be filled in by the main applicant (legal entity!) of this proposal. The main applicant
appoints a project leader (employed by the main applicant) who is responsible for submission of the
project proposal and correct execution of the project. The project leader is the first contact person
for IWT.
If more than one department or research group of the main applicant is involved in the project
execution, these groups are not considered as separate applicants. They all belong to the same
applicant. If the project will be granted, the payments will be executed on the level of the legal
entity, not on the level of the research group. The correspondence for the payments will be
addressed towards the first contact person of each applicant.
The main applicant encloses a signed declaration of intent (see enclosures “Intentieverklaring”).
Title of the project
Main Applicant
(Organisation/legal entity)
Research Group 1
Department/Division
For organisations that contain
both a university and a
university hospital, please
indicate whether this research
group is officially affiliated
with the hospital or not.
Addresse
yes/no
Name project leader
Function project leader
Phone project leader
Fax project leader
e-mail project leader
Research Group 2
Department/Division
For organisations that contain
both a university and a
university hospital, please
indicate whether this research
group is officially affiliated
with the hospital or not.
Contact person
Research Group 3
Department/Division
For organisations that contain
both a university and a
university hospital, please
indicate whether this research
group is officially affiliated
with the hospital or not.
Contact person
yes/no
yes/no
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In case the main applicant includes a large subcontractor(s) in its budget:
Name Subcontractor 1
Addresse
Name Subcontractor 2
Addresse
Total Budget main applicant
Total manpower main
applicant (mm)
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C. Administrative Data Co-Applicant(s) (if relevant)
This part should be filled in by each co-applicant (legal entity) of this proposal.
If more than one department or research group of a co-applicant is involved in the project execution,
these groups are not considered as separate co-applicants. They all belong to the same co-applicant.
If the project will be granted, the payments will be executed on the level of the legal entity, not on
the level of the research group. The correspondence will be addressed towards the first contact
person of the co-applicant.
Each co-applicant encloses a signed declaration of intent (see enclosures “Intentieverklaring”).
Title of the project
Co-Applicant X
(Organisation/legal entity)
Research Group 1
Department/Division
For organisations that contain
both a university and a
university hospital, please
indicate whether this research
group is officially affiliated
with the hospital or not.
Addresse
yes/no
Name of the first contact
person of this co-applicant
Function
e-mail
Research Group 2
Department/Division
For organisations that contain
both a university and a
university hospital, please
indicate whether this research
group is officially affiliated
with the hospital or not.
Contact person
Research Group 3
Department/Division
For organisations that contain
both a university and a
university hospital, please
indicate whether this research
group is officially affiliated
with the hospital or not.
Contact person
yes/no
yes/no
In case the co-applicant includes a large subcontractor(s) in its budget:
Name Subcontractor 1
Addresse
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Name Subcontractor 2
Addresse
Total Budget co-applicant X
Total manpower co- applicant
X (mm)
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Application Form TBM
Part 2: Project description
This part should be filled in by the main applicant, in dialogue with the co-applicant(s).
This template clarifies the information that is needed in order to evaluate the project. More
information on the evaluation criteria can be found in the document “TBM Handleiding”.
The maximal number of pages is indicated between brackets (excl. references) and includes a
readable font with sufficient line spacing and margins. Exceeding the page limits will compromise the
eligibility of the project.
The project description should be in English.
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A. Fit of the project in the TBM programme (Max. 1 pg.)
This section should be sufficient in order to evaluate the “fit” of the project in the TBM-programme!
A.1. Fit of the project in the TBM programme (Max. 1 pg.)
Indicate why this proposal fulfills the four criteria of the “fit” in the TBM programme:
1.
A TBM project aims at the development of a new therapy, diagnosis and/or specific prevention
of a particular illness.
2. A TBM project is directed at research that is positioned late in the path from discovery to a specific
application and aims at translating and developing scientific findings into clinical applications
rather than creating knowledge from scratch. It is not focused on early stage research (too early),
nor is it directed towards pure implementation activities (too late).
3. A TBM project offers a clear applicability with an added value for the Flemish health situation
(including a positive medical impact for a certain group of patients).
4. At the time of submitting the application (or in the near future) there is not any industrial interest
in the TBM project (due to a commercial reason).
Give special attention towards the motivation for criteria (2) and (4). Give an answer to the following
questions: Which proof of concept was obtained? and Why is industry currently not interested?
B. Rationale, state of the art and innovation goal (Max. 7 pg.)
This section is designed to provide a picture of the larger context of the project: a description of the
rationale of the project and a description of how the project fits into the current state of the art. It will allow
IWT to assess the degree of novelty, originality and creativity of the project application as well as the
complementarity with previous and ongoing research.
In addition this section also includes the innovation goal. This innovation goal will be included in the IWT
agreement and will be used at the end of the project to determine to what extent the established objectives
were achieved. This is one of the reasons why it is necessary to delineate the objectives as clearly as
possible, to ensure that they are concrete and verifiable. Note that the IWT agreement entails an obligation
to provide the required resources and not an obligation to obtain the expected results.
B.1. Rationale (Max. 1 pg.)
Define the problem by describing the questions and difficulties to be resolved by this project. Sketch briefly
the essence of the solution that is proposed in this project.
B.2. State of the art/Novelty (Max. 5 pg.)
Describe the present state-of-the-art for the project, based on literature and patent searches. If the
applicants are already active in the project field, give an overview of the results achieved so far. Indicate
any interface with other IWT-funded projects or projects supported by other organizations.
Describe the added value of the project compared to the current knowledge/state-of-the-art and other
initiatives. Indicate the innovative aspect of your project. Indicate the comparative advantage of this
project compared to other initiatives. Explain why this project, when successful, will have an impact on the
progress of scientific knowledge in the field.
B.3. Innovation goal (Max. 1 pg.)
Describe the final utilisation goal of this project in 1 or 2 paragraphes.
Describe the scientific objectives for the project period. Present the objectives as short and clear
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statements.
Please also provide a Dutch version of this section.
C. Utilisation of the project results (Max. 6 pg.)
In this chapter the added value of the project is described.
C.1. Added Value (Max. 3 pg.)
Indicate the potential applications of the project results and illustrate the importance of these applications
for the Flemish society (in terms of numbers of patients, medical impact per patient, socio-economic
impact).
Illustrate the relevance and the strategic value of the proposed research to offer a solution for a demand
relevant for society.
C.2. Utilisation strategy (Max. 2 pg.)
Illustrate the strategy that will be followed to utilise the results, i.e. bring the results to the relevant patient
group. Indicate all activities (including R&D) that have to be performed after this project in order to be able
to transfer the results to the patients.
Describe whether the total patient group (in Flanders in particular) or only a fraction of the patient group
will be reached. How will this be achieved?
Indicate possible hurdles for utilisation of the results (scientific, regulatory, ethical,…) and proposed
solutions to these hurdles.
Indicate whether the obtained results will be transferred on a non-profit basis or not.
C.3. Intellectual property rights of the project results (Max. 1 pg.)
Describe the existing intellectual property rights of the applicants that are relevant for the project. Describe
the importance of these rights for the utilisation of the project results.
Indicate the freedom to operate for the utilisation of the project results.
If relevant, describe the strategy towards protection of the project results.
If companies will be involved in the utilisation of the project results on the longer term, describe how the
exploitation rights of the project results will be transferred on a “free market” basis
D. Research Approach and work programme (Max. 10 pg.)
This chapter describes the research strategy (approach, work hypotheses), the choice of methodology, the
motivation for the allocated resources (man months, required expertise, infrastructure,…) and the
motivation for the feasibility of the project within the project period (milestones, go/no-go decisions,…).
D.1. Research approach
Describe the way in which the project is approached and explain why this approach has been chosen and
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Application Form TBM
why certain strategic choices were made, if applicable. The approach should clarify how the project goals
will be achieve.
Based on the global approach, describe the structure and relationship between the work units.
D.2. Work programme
Give a detailed project description including a detailed work programme divided in work units and tasks.
Describe each of the work units/tasks. Clearly indicate deliverables, milestones and go/no go decisions.
Indicate the scientific/technological risks associated with the project and explain how these risks will be
tackled. Indicate the contribution of each of the participating research groups (and if applicable, the
subcontractors) in the work plan. Describe whether the methods and materials that will be used are at
present available in the laboratory or, alternatively, how access to these methods and materials will be
achieved.
Give in a project plan the allocated manpower and the positioning in time for each of the work units. Below
an example is given for such a project plan (for a project of four years). Personnel allocation should be
given as estimated person-months. Please note that the manpower is asked for each of the contributing
research groups (not only for each of the participating organisations!)
Research group 1
(Applicant 1) (pm)
Y1
Y2
Y3
Y4
Research group 2
(Applicant 1) (pm)
Y1
Y2
Y3
Y4
Research group 3
(Applicant 2) (pm)
Y1
Y2
Y3
Y4
work unit 1
work unit 2
work unit 3
…
TOTAL
Q
1
work unit 1
Year 1
Q
Q
2
3
Q
4
G
1
Q
1
Year 2
Q
Q
2
3
Q
4
Q
1
Year 3
Q
Q
2
3
Q
4
Q
1
Year 4
Q
Q
2
3
Q
4
work unit 2
M1
work unit 3
…
G1= go/no go decision 1:…
M1= milestone 1:…
Indicate how the project will be managed.
E. Expertise and track record of the applicant(s) (ca. 1-2 pg.)
This chapter gives an overview of the expertise and track record of the participating research group(s). The
track record also includes the correct execution of previous IWT projects, as well as the utilisation of these
projects.
E1. Scientific expertise and track record
Describe for each participating research group the expertise/track record relevant for the execution of the
project. Give a short overview of the previous and ongoing research projects of the participating research
groups in the field of this project (for the last 5 years).
What is the role and added value of each research group within the consortium?
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E2. Expertise/track record with regard to the utilisation of the project results
Describe for each participating research group the expertise/track record relevant for the utilisation of the
project results.
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Part 3: Project budget
Each applicant fills in a project budget table. The main applicant combines all data and fills in the
total budget table.
The project budget is prepared as described in the documents “TBM handleiding” and the IWT cost
model”. The costs are subdivided in staffing costs, other costs (working costs, equipment costs,
indirect costs) and large subcontractor costs.
It is important that the project budget is in balance with the work programme and the expected
results. “Value for money” is an evaluation criterion.
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Part 4: Enclosure(s)
The main applicant combines all enclosures.
The mandatory enclosure(s) are:
A. Signed declaration of intent of all applicants
B. Signed declaration of project leader
C. Approval(s) of the ethical committee(s) (if relevant): If authorization by an ethical commission is
required for project execution, the official approval should be sent to IWT as soon as possible. In
any case, for projects that have been selected for funding, the official authorization document
has to be made available to the IWT at the latest 9 months after the start of the project. If not,
project funding will be aborted.
D. Quote for each subcontractor that is a company
E.
Motivation for the large project cost
Additional information (list of publications, details about former projects) can be enclosed with the
application form, but this information might not be sent to the experts.
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A. Declaration of intent (intentieverklaring) of the applicant(s)
All applicants (= participating legal entities!), including the non-Flemish applicants, have to
sign a declaration of intent with the following text. The text should be completed with the specific
data from the project, and should be added to the project application. The letter should be signed by
a person that is competent to arrange contractual commitments for the legal entity.
An English version of this template can be found at http://www.iwt.be/subsidies/tbm/documenten. It
is, however, the Dutch version that should be signed!!
Aanvrager X:
Rechtspersoon
Naam van de gemachtigde van deze
instelling/rechtspersoon:
Deelnemende onderzoeksgroep(en)
behorende tot deze instelling/rechtspersoon:
-
“Als gemachtigde van <aanvrager X(= rechtspersoon!!)> verklaar ik kennis te hebben genomen van
en akkoord te zijn met de projectaanvraag “<titel van het project>“ ingediend in het kader van het
TBM-programma oproep <jaartal> door <naam projectleider> verbonden aan <hoofdaanvrager> in
samenwerking met <mede-aanvrager(s)>1.
De <aanvrager X> heeft tevens kennis genomen van de modaliteiten van het TBM-steunkanaal zoals
beschreven in de Handleiding TBM.
Ondergetekende bevestigt de intentie te hebben het eigen werkdeel en de samenwerking met de andere
aanvragers1 in het kader van dit project volgens plan uit te voeren en geeft hierbij het IWT-Vlaanderen
de toestemming om alle nodige enquêtes uit te voeren die nodig zijn voor de evaluatie van deze
projectaanvraag.
Ondergetekende bevestigt ook dat de projectaanvraag aansluit bij de doelstellingen van het TBMsteunkanaal en niet via andere steunkanalen wordt gefinancierd.
Ondergetekende verklaart dat <aanvrager X>, in geval er binnen de organisatie ook economische
activiteiten uitgevoerd worden, een boekhouding voert die toelaat de projectkosten eenduidig te
identificeren en te onderscheiden van deze economische activiteiten.
Tevens verklaart ondergetekende dat de instelling op datum van deze aanvraag in orde is met betrekking
tot de nodige vergunningen en dat indien voor het project specieke authorisaties of verzekeringen
vereist zijn, deze tijdig zullen aangevraagd worden en dat de activiteiten die dergelijke
authorisaties/verzekeringen vereisen niet zullen uitgevoerd worden zonder dat deze
authorisaties/verzekeringen bekomen werden.”
<Naam gemachtigde aanvrager X>
<Handtekening + datum>
1
indien van toepassing: alle rechtspersonen die mede-aanvrager zijn van het project
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B. Declaration (verklaring) of the project leader
The project leader has to sign a declaration with the following text. The text should be completed
with the specific data from the project, and should be added to the project application.
Als projectleider van de projectaanvraag “<titel van het project>“ ingediend in het kader van het TBMprogramma oproep <jaartal> verklaar ik, ondergetekende, dat:
(1) alle in deze projectaanvraag vermelde contactpersonen voor de deelnemende onderzoeksgroepen op
de hoogte zijn van en akkoord zijn met hun –in deze projectaanvraag beschreven– bijdrage aan het
projectvoorstel.
(2) het aandeel van de Vlaamse ziekenhuizen of het ITG gecumuleerd minstens 10% van de totale
projectbegroting bedraagt.
<Naam projectleider>
<Handtekening + datum>
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