Western Michigan University Research Foundation  Office of the Vice President for Research
TECHNOLOGY DEVELOPMENT FUND APPLICATION
I.
APPLICANT INFORMATION
1. Principal Investigator
_______________________________________________________________________
2. Academic Rank
_______________________ Dept./Unit ________________________________________
3.
Co-Investigator
__________________________________________________________________________
4.
Academic Rank
________________________ Dept./Unit ________________________________________
5. PI's Campus Address/Box ____________________ Phone/E-mail _____________________________________
II.
PROJECT INFORMATION
6. Project Title
_______________________________________________________________________________
___________________________________________________________________________________________
7.
WMU IP & Commercialization Case number ____________ (Note: this number must be provided in order to be
eligible for this program).
8.
Amount Requested: ______________________________ Cost share (if applicable)
9.
Names/Departments of Key Collaborators
____________________
_______________________________________________________
__________________________________________________________________________________________
10. Does the Proposed Project Involve:
Use of Human Subjects
______Yes ______No
If yes, status of review*
______________
Use of Vertebrate Animals ______Yes ______No
If yes, status of review*
______________
Recombinant DNA
If yes, status of review*
______________
_______ Yes ______No
Non-clinical lab studies regulated by the FDA (quality assurance required) __________Yes
__________No
*submitted or approved
11. What is your current support for this project (if any)?
Indicate whether these are external or internal funds (e.g., NSF, FRACASF, BRCC, MUCI, industry contracts, etc)
Where/When submitted?
_____________________________________________________________________
Amount of funding, starting and ending dates _____________________________________________________
Project title ________________________________________________________________________________
12. List any pending support related to this project (see page 2).
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Pending Support Related to this Project
Failure to provide this information may delay consideration of this proposal.
Investigator:
Support:
Pending
Submission Planned in Near Future
Project/Proposal Title:
Source of Support:
Total Award Amount: $
Support:
Total Award Period Covered:
Pending
Submission Planned in Near Future
Project/Proposal Title:
Source of Support:
Total Award Amount: $
Support:
Total Award Period Covered:
Pending
Submission Planned in Near Future
Project/Proposal Title:
Source of Support:
Total Award Amount: $
Support:
Total Award Period Covered:
Pending
Submission Planned in Near Future
Project/Proposal Title:
Source of Support:
Total Award Amount: $
Support:
Total Award Period Covered:
Pending
Submission Planned in Near Future
Project/Proposal Title:
Source of Support:
Total Award Amount: $
Total Award Period Covered:
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III. PROPOSED PROJECT (Total funding requested is not to exceed $20,000).
A. PROJECT DESCRIPTION – (Not to exceed 1 page) Please provide a detailed description of the project and the tasks to
be performed. Be sure to provide: 1. The current state of the technology/project (briefly, what has been accomplished to date?); 2.
Specific aims or goals of the project; 3. A rationale for why these funds are being sought (what problem are you attempting to solve)
and how this will help move the project towards commercialization.
The review committee will be provided a copy of the invention disclosure form and technical description at the time of the review to
address technical questions.
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B. MARKET RELATED QUESTIONS:
1. As a commercialization committee we are interested how ideas become products. For your concept,
who do you think would be the person/entity who orders or purchases the product? If that person is different than
the person/entity who uses the product, try to describe that relationship. Please try to be specific.
2. Please try to describe the number of units of your concept that might be manufactured, sold, or
consumed. For example, does every person in America need this invention/concept, or is it one per organization
(i.e., how large is the market)? Is it a product limited to one industry or are there multiple applications, and what
are these?
3. Within a range, what might be a reasonable price for your concept/product? Are there other products in the
general category that might provide some insight as to a price?
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C.
BUDGET SUMMARY*
COST SHARE
CATEGORY
REQUESTED from WMURF
TOTAL
Salaries
and Wages
Faculty _______________
_____________
_________
Grad Student _______________
_____________
_________
Undergrad _______________
______________
_________
Fringes
_______________
_____________
_________
Supplies/
Materials
________________
______________
_________
Equipment
________________
______________
__________
Other (Itemize)
________________
______________
__________
TOTALS:
_________________
_______________
__________
* The committee would prefer that projects do not contain support for faculty salaries, or at the very least the budget
should reflect a relatively small proportion of funding devoted to faculty salary support.
D. BUDGET JUSTIFICATION (limit ½ of page). Provide justification for each budget item.
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E. KEY PROJECT MILESTONES
Include at least three (3) project specific developmental milestones tied to the Project Description that will demonstrate
progress towards the overall goal, and the time required to reach each of these milestones.
Please be a specific as possible. If the milestone is generic (such as “complete 1st generation prototype”), you must describe
the expected specifications, attributes, and/or functionality for this level of development, such that one could objectively
determine whether the milestone has been achieved.
F. CURRICULUM VITAE
Please include a current CV for the PI and any Co-PIs.
G. OTHER SUPPORT DISCLOSURE GUARANTEE
The above listing is an accurate and complete accounting of all funds, internal and external, available to support the
proposed project (and related projects) discussed herein and other information supplied regarding the requested funding
is true and accurate.
__________________________________________________________________________
Principal Investigator
Date
__________________________________________________________________________
Co-Investigator
Date
__________________________________________________________________________
Dept. Chair(s)
Date
___________________________________________________________________________
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