CONFIDENTIAL
CQDM EXPLORE PROGRAM
For internal use
File # : [Keywords]
A CQDM/OCE PARTNERSHIP FUNDING OPPORTUNITY
OPENED TO THE SCIENTIFIC COMMUNITY OF QUEBEC AND ONTARIO
LETTER OF INTENT
DEADLINE: SEPTEMBER 25th, 2014
This form must be filled in with “Arial 11” font, typed at 1.15 line spacing
AMOUNT REQUESTED :
[Comments]
TITLE OF THE PROJECT (In English)
[Title]
TITLE OF THE PROJECT (In French)
DELIVERABLES
IDENTIFICATION OF THE PRINCIPAL INVESTIGATOR (PI)
Last name:
First name:
Organization/University:
Department/Faculty:
Address:
City:
Country:
Province:
Phone #:
Postal code:
Ext:
Email:
EXPLORE PROGRAM/LOI application form 2014
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CONFIDENTIAL
AMOUNT REQUESTED:
TITLE OF THE PROJECT:
[Comments]
CQDM FILE #:
[Keywords]
[Title]
SECTION 1. IDENTIFICATION OF THE RESEARCH GROUP (PIs and CO-INVESTIGATORS). Add lines if necessary
Name
Affiliation
(Organization,
Province)
EXPLORE PROGRAM/LOI application form 2014
Email address
Contribution to
the project
Academia or % of the budget
private
allocated to this
sector
group
Discipline
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CONFIDENTIAL
AMOUNT REQUESTED:
TITLE OF THE PROJECT:
[Comments]
CQDM FILE #:
[Keywords]
[Title]
SECTION 2. PROJECT SUMMARY (maximum 2 pages)
Describe the project by outlining the following aspects of your research:
 Rationale
 Background and/or preliminary results
 Objectives
 Research Plan
o Methodological approach
o Principal steps
o Expected results
o Milestones and go/no go decision points
o Deliverables
EXPLORE PROGRAM/LOI application form 2014
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CONFIDENTIAL
AMOUNT REQUESTED:
TITLE OF THE PROJECT:
[Comments]
CQDM FILE #:
[Keywords]
[Title]
SECTION 3. IMPACT ON THE DRUG DISCOVERY/DEVELOPMENT PROCESS (Max 1 page)
1) Identify the most important challenges currently faced by the pharmaceutical industry and describe how your
proposed project will address them
2) Explain how the expected results of the research project can impact the drug discovery and development process.
Please specifically discuss the following possible impacts (if applicable):
 Opening new therapeutic approaches and research avenues
 Bringing more effective medicines to the clinic and to the market
 Increasing the efficacy of existing drugs
 Reducing the R&D costs, time to market or the risks of development
 Other impacts on the drug discovery and development process
EXPLORE PROGRAM/LOI application form 2014
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CONFIDENTIAL
AMOUNT REQUESTED:
TITLE OF THE PROJECT:
[Comments]
CQDM FILE #:
[Keywords]
[Title]
SECTION 4. INNOVATIVE AND UNIQUE CHARACTER OF THE PROJECT (Max 3/4 page)
1) Describe the novelty and the originality of the proposed project and explain how it could lead to a major
breakthrough, or could become a game changer for biopharmaceutical research
2) Identify the most important competing technologies, computational tools, novel approaches, techniques and
devices (existing or in development; direct or indirect) that aim to achieve the same goal as your proposed project
and:
 Describe how your technologies, computational tools, novel approaches, techniques and devices will bring
added value to pharma when compared to the identified competition
 Identify the unique and most important differentiating factors of your proposed technologies, computational
tools, novel approaches, techniques and devices compared to the identified competition (at the local and
international levels) focusing specifically on the scientific aspects of the technologies, computational tools,
novel approaches, techniques and devices and not on the excellence of the team or facilities
EXPLORE PROGRAM/LOI application form 2014
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CONFIDENTIAL
AMOUNT REQUESTED:
TITLE OF THE PROJECT:
[Comments]
CQDM FILE #:
[Keywords]
[Title]
SECTION 5. PRELIMINARY BUDGET – (maximum ½ page)
ESTIMATED COSTS OF PROJECT
Year 1
Year 2
TOTAL
Salaries and benefits
(research staff, payment to students)
Material and supplies
Travel expenses
(conferences, seminars, symposia fieldwork)
Publication and dissemination costs
Services
Overheads (15% maximum)
Other (please specify)
TOTAL PER YEAR
Please indicate if there are other sources of funding for this project:
EXPLORE PROGRAM/LOI application form 2014
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CONFIDENTIAL
[Comments]
AMOUNT REQUESTED:
TITLE OF THE PROJECT:
CQDM FILE #:
[Keywords]
[Title]
SECTION 10. SIGNATURE OF PIs AND ALL CO-INVESTIGATORS (add pages, if necessary)
Please note that the full proposal must be signed by the PIs and all the co-investigators
1. I authorize CQDM/OCE to exchange all information relating to this application for analysis or evaluation
purposes, provided that all persons granted access to this information treat it in the strictest confidence.
2. I understand that the intellectual property resulting from this project will belong to the inventor(s) and
their institutions and that a non-exclusive end-user license option will be granted to the CQDM
industrial sponsors. The terms of said license option will be negotiated before the beginning of the
project no later than 2 months following the confirmation of the funding.
3. I agree that, if this project is retained for funding, I will facilitate the signing of an agreement with
respect to the option on the IP generated by this project.
4. I certify that all information provided in this application is complete and accurate to the best of my
knowledge.
Signature of the PI:
Name:
Date:
Signature of the co-investigator:
Name:
Date:
Signature of the co-investigator:
Name:
Date:
Signature of the co-investigator:
Name:
Date:
EXPLORE PROGRAM/LOI application form 2014
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CONFIDENTIAL
[Comments]
AMOUNT REQUESTED:
TITLE OF THE PROJECT:
CQDM FILE #:
[Keywords]
[Title]
SECTION 11. RESEARCH ENTITIES’ (PUBLIC AND PRIVATE) SIGNATURE OF PIs AND ALL CO-INVESTIGATORS (add pages, if
necessary)
1. I certify that I am a signing officer of the research entity representing investigator(s)* _______________________
________________________________________ and that I have the authority to commit the research entity with my sole
signature.
2. I read the content of this application and I certify that the information provided in this form is complete and accurate to the best
of my knowledge.
3. The research entity supports this application and agrees to provide the functional laboratories or research facilities and the
equipment necessary for conducting this research project.
Signature :
Name:
(Print)
Title:
Organization :
Date:
*List the name(s) of the investigator(s) submitting this application and who are affiliated to your research entity.
EXPLORE PROGRAM/LOI application form 2014
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