GENOME BRITISH COLUMBIA USER PARTNERSHIP PROGRAM STATEMENT OF INTEREST (SOI) GENERAL INSTRUCTIONS Please delete this page before submitting the Statement of Interest (SOI). User organizations that wish to register their interest in partnering with researchers at BC-based research institutions to undertake a specific project through this program should submit a Statement of Interest (SOI) to Genome BC. Genome BC will be pleased to assist in defining goals, articulating user benefits, and answering questions concerning the program. Please note that Genome BC may share the information contained within this Statement of Interest with potential researchers and partners. SOIs will be accepted on a rolling basis on or after July 29, 2013. Please consult the User Partnership Program Guidelines for details of this program. SOIs should be submitted in PDF format by email to Genome BC at UPP@genomebc.ca. Type must be single-spaced, font Arial, size 11 point. UPP Statement of Interest- v1.0. Issued July 16, 2013. 1 GENOME BRITISH COLUMBIA USER PARTNERSHIP PROGRAM STATEMENT OF INTEREST (SOI) User Organization Organization Name Name and Title of Signatory1 Phone Number Email Signature Type of Organization2 Contact Person3 Name and Title Address Phone Number Email Project Title 4 Date of Submission Relevant Sector(s)5 Project Duration 1 The SOI must be signed by a senior representative of the User Organization who has the authority to confirm the financial co-funding contribution provided by the User organization to the project. Signature confirms that this SOI has been reviewed and approved for submission to Genome British Columbia. 2 Indicate the type of organization, for example: Industry, Government agency or not-for-profit organization 3 Contact person for the organization will be the point person for all communications with Genome BC 4 The Project Title can be changed at the point of application if desired 5 Indicate the sector or sectors that relate to the proposed research, for example: forestry, fisheries/aquaculture, agriculture/agri-foods, environment, bioenergy, mining or human health. More than one sector can be indicated if relevant. UPP Statement of Interest- v1.0. Issued July 16, 2013. 2 Project Concept (3 pages maximum) 1) Describe the demand for this research to meet the needs of a key BC sector How is the problem currently being addressed (if at all), by whom, and what are the limitations to current practice? What is the potential market (if appropriate) and competitive landscape? If the user organization does not have a presence in BC, what is the capacity for uptake by other users in BC? 2) Outline the Potential Impact of the Project What is the problem to be addressed; why is it important to the user organization; and how can genomics or molecular biology be utilized to develop a solution? What are the proposed shortterm and long-term outcomes? What does success look like? What impact would the new approach have and who will be impacted? 3) Outline the Proposed Project Plan Primary research objective(s) of the project, scope of work, and proposed approach. Briefly describe similar or competing research ongoing elsewhere. If such research exists, how does this proposal align with it? 4) Describe any existing partnership, if applicable How are the current user-research partnerships structured? What do the various players bring to the partnership? 5) Outline the Strategy for Implementation What is the plan for commercialization/implementation to ensure user uptake? If Intellectual Property (IP) is expected to arise from this project, how will it be handled? What are the potential barriers for market entry or user uptake, and how will these be addressed? Who is the major beneficiary of this research and who may be negatively impacted? 6) Clarify changes if project is a resubmission How is this submission different from the original one? How have concerns/barriers been addressed? UPP Statement of Interest- v1.0. Issued July 16, 2013. 3 Other Potential Partner(s) (optional) Name and organization Name and organization Name and organization Name and organization Potential Research Leader(s) (optional) Name and affiliation Name and affiliation Name and affiliation Name and affiliation Project Budget Total ($) Total Contribution from User Partner ($) Cash In-kind6 Potential Contributions from Other Partners Organization and amount Other Potential Co-funding Source and amount Genome BC Ask ($) 6 Provide estimated equivalent cash value for any anticipated in-kind contributions. Eligible in-kind contributions can include personnel or consumables. In-kind contributions are evaluated on a case-bycase basis. UPP Statement of Interest- v1.0. Issued July 16, 2013. 4