Global Commerce Support Program - Going Global Innovation - Application Form

Common Data Collection Notice: Completing the appropriate sections of the application requesting your name, address telephone numbers and e-mail address will signify your consent to use your contact information for this specified purpose.

SECTION 1: Project Lead Information

1.1 Project Leader

Name:
Title:
Legal Name of Institution/Organization:
Telephone:
Fax:
E-mail:

1.2 Organization

A. Main Address

Number and Street:
City:
Province:
Postal Code:
Type (Academic, Industry, Non-government research institute):

B. Mailing Address

Number and Street:
City:
Province:
Postal Code:

C. Courier Address

Number and Street:
City:
Province:
Postal Code:

1.3 Authorized Signing Authority for the Institution

Name:
Title:
Institution/Organization:
Address:
Telephone:
Fax:
E-mail:

SECTION 2: Project Information

2.1 Project title (in 10 words or less):

2.2 Proposed project dates (overall for entire project):

2.3 Proposed travel dates (overall departure & return):

2.4 Applicable research area(s) (select all that apply):

(Please tie the research area to the intended application/outcome of the R&D)

( ) Environmental science and technologies
( ) Natural Resources and energy
( ) Information and Communication Technologies
( ) Health and related life sciences and technologies
( ) Other:

2.5 Executive summary of the project (Provide a brief synopsis outlining the purpose and reasons for the activity/ activities to be undertaken during this mission - maximum 500 words):

2.6 What are the objectives and expected outcomes of the project? (outline what is to be achieved and what will be the end result of the project)

2.7 Clearly and concisely explain the proposed joint partnership.
(explain clearly the joint collaboration being sought between both parties).

2.8 What methodology is being used in order to advance/solidify this partnership? (for example, will there be workshops, one-on-one meetings, presentations, site visits etc). Include meeting agenda and/or work program.

2.9 Clearly and concisely outline the roles of both the Canadian and foreign participants.
(Outline how and what each partner (Canadian and foreign) will participate/contribute to the collaboration)

2.10 Describe the complementary knowledge, expertise or technology being brought to the collaboration by the foreign counterpart(s), making sure to explain clearly why this knowledge, expertise or technology is not available within Canada or why these foreign counterparts are ideal partners.
(Outline what the foreign partner is bringing to the collaboration in terms of knowledge, skills, expertise, technology etc).

2.11 Describe potential downstream activities (research, commercialization) that is expected to flow from this joint R&D collaboration.

2.12 Explain the funding sources being planned for subsequent stages related to the R&D collaboration. (e.g. Venture Capitalists, Angel investors, company revenue, government sources, granting councils, etc.)

SECTION 3: Participant and Partner Information

3.1 Canadian Participants:
(Provide coordinates for each Canadian participant seeking funding. This list must be consistent with the activity table in section 4, and the budget details tab – Add as required).

Name:
Title:
Institution:
Mailing address:
Telephone:
Fax:
E-mail:
Type (Academic, Industry, Non-government research institute):

Name:
Title:
Institution:
Mailing address:
Telephone:
Fax:
E-mail:
Type (Academic, Industry, Non-government research institute):

3.2 International Counterparts:
(Provide full coordinates for each foreign participant – Add as required)

Name:
Title:
Institution:
Mailing address:
Telephone:
Fax:
E-mail:

SECTION 4: Activities

Activity Details
(list for each activity)

Activity Title	Travel Dates	Description	Destination	Number of Canadian Participants	Number of Foreign Participants
Total number of participants				XX	XX

SECTION 5: Prior Going Global Experience

5.1 Have you previously applied for Going Global funding? Was your project approved under the program?

5.2 Please provide a brief description of the results that were achieved from the previously approved project.

SECTION 6: Basis of Payment

6.1 If successful, will you (the project lead/recipient) be incurring costs on behalf of participants for their eligible expenses prior to the reimbursement payment from Going Global Innovation?

Yes | No | Not applicable*

*If application involves only the Project leader as the Canadian participant seeking funding