Application form
This proforma covers all forms and duration of awards under the Hermes fellowship programme – please
complete the form providing sufficient information for the reviewers to fully assess the case.
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Applicants for Business Innovation Vouchers and Events need only complete sections 1, 2 & 5-7.
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Applicants for Outreach Fellowships should complete sections 1, 2 and 5-7 and provide a Gantt
chart if appropriate.
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Applicants for Business Fellowships should complete sections 1, 2, 3 (if appropriate) and 5-7 and
provide a Gantt chart.
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Innovation-based applications should complete all sections except 3, in association with the
Technology Transfer Office, and provide a Gantt chart.
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All applications for buy-out fellowships must include a CV and letter of support from their head of
School. Applicants for industrial secondments must also provide a letter of support from the
industrial host.
Applicant Name(s), position:
Telephone:
School:
Email:
Title of Proposed Award:
Funding sought
Duration (months)
Start date
UoN Priority Group association (preferred but NOT essential)
HEIF Deliverables:
Activity:
SME engagement
Potential to secure income from Business Engagement through:
Services Rendered/CPD Delivery
Consultancy
Contract/Collaborative Research
Supporting Technology Translation
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Engaging with the external community for defined social/economic benefit
Other – please specify:
Income generation:
Please indicate the potential income to the University to be secured through this fellowship, from what sources,
and the time period over which the income could be secured.
Exec Summary: Please give short NON-CONFIDENTIAL summary of the work to be undertaken during
the fellowship and the potential economic and or social benefit to the UK. (200 words max)
Section 1
Please summarise (bullet points) the key deliverables that you expect to accomplish within the timeframe of the award with particular reference to the impact on outreach (including public and cultural
engagement), business engagement or commercialisation:
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Section 2
2a Summarise the work you intend to carry out and how the award will help to achieve the outcomes, with
particular reference to the judging criteria. (1000 words max)
2b Identify any related projects, and their funding source, the outputs of which are the subject of this
proposal.
Source
Indicative date(s)
Outcomes
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Section 3 If applying for secondment to industry or other external organisations, please provide details of
the external partner organization.
What would be the contribution of the external partner organisation?
Direct:
In kind:
Section 4 Innovation-based applications only:
This section should be completed with the aid of the Technology Transfer Office – see contacts list in
guidance notes.
4a Need (400 words)
What is the need your technology will help to address? What is your proposed solution and how long will it
take to develop? What stage will the technology be at the end of the award? Which source(s) of funding
will you apply to in order to further develop the technology?
4b Intellectual Property
What is the nature and status of the IP
4c The Market (200 words)
Summarise the potential for the proposed product or service, e.g. market size, location of market, internal
market (who do you see as being your “customers”?). What actions do you plan to engage with the
market to ensure that the development of your idea meets market demand and expectation?
4d Competition (200 words)
Who/what are the main competitors or competing ideas (in which region /country)? What are the key
factors that will enable this innovation to compete successfully in the market place?
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4e Barriers to Commercialisation, market entry and acceptance. (200 words)
What are the main hurdles to be overcome before the idea or product is likely to reach the market place?
Where do you anticipate that the main risks lie (these may not necessarily be technical in nature)?
4f Statement of support from Technology Transfer Office. (200 words)
4g Name of TTO assessor:
Signature:
Section 5 Outcomes
Summarise the potential outcomes for the proposed activity, barriers to success and where the main risks
lie. (250 words)
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Section 6 Financial - Full Economic cost of project activity
Cost area
Cost sub-heading
Directly incurred costs
Staff costs (i.e. salary costs include N.I. and
Superannuation costs)
Business Innovation Voucher
Business Engagement Event
Germinator award/mentor
Travel & subsistence
Consumables
Essential equipment (limited to 10% of funds
requested)
Market assessment
Consultants /subcontracting
Other (e.g. animal costs)
Sub-total
Directly allocated costs
Investigators
Estates costs
Other directly allocated
Indirect costs
Indirect costs
TOTAL
Funds requested
from Hermes Awards*
*NB. Only directly incurred costs will be funded therefore the funds requested should not exceed the
value of directly incurred costs: full economic costs are requested so that the University contribution to
this programme can be recorded.
Is there any additional / matched funding from other organisation(s) such as
another HEI, regional body or external collaborator? Give further details of
such funding here:
Justification of costs: provide a brief explanation of funding requested. For example, Give details of name
of person to be bought out, and state reasons for any intended travel
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Section 7
Signatures and authority to apply for a Hermes Fellowship Award
Applicant(s):
Signature(s)
Name(s)
Date
Name(s)
Date
Head of School:
Signature
Name
Date
The Head of School signs to approve the application
Notes for submission:
Applications requiring input from the TTO should be submitted to the TTO by Monday 16 November
2015
All electronic applications must be received by the deadline of 9am Monday 23 November 2015
Following electronic submission, a signed hard copy should be submitted within 5 days of the deadline.
Return completed forms to:
david.southall@nottingham.ac.uk
David Southall
Innovation Fellowships Manager
Technology Transfer Office
Business and Innovation Services (BEIS)
Sir Colin Campbell Building
University of Nottingham Innovation Park
Triumph Road
Nottingham
NG7 2TU
Completed applications forms should include:
[1] The completed and signed application form
[2] A Gantt chart showing key activities and milestones.
[3] CV for academic buy-out fellowships
[4] Letter of support from Head of School for buy-out fellowships
[5] Letter of support from industrial host for secondment fellowships
The Gantt chart should extend beyond the period of the Award indicating the plans and activities that will
occur in the months following the funding.
Business Engagement and Innovation Services (BEIS)
The University of Nottingham
Sir Colin Campbell Building, Jubilee Campus, NG7 2TU
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