CONFIDENTIAL
EXPLORE PROGRAM 2013
For internal use
File # : [Keywords]
PRELIMINARY APPLICATION (LETTER OF INTENT)
DEADLINE: FEBRUARY 28th, 2013
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)
PLEASE CHECK THE RESEARCH THEME(S) COVERED BY THIS APPLICATION
BIOLOGICS
MODULATING PROTEIN-PROTEIN INTERACTION
INNOVATIVE DRUG DELIVERY TECHNOLOGIES
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 2013
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CONFIDENTIAL
[Comments]
AMOUNT REQUESTED:
TITLE OF THE PROJECT:
CQDM FILE #:
[Keywords]
[Title]
IDENTIFICATION OF THE RESEARCH GROUP (PI AND THE CO-INVESTIGATORS) (including those from
private organizations). Add lines if necessary
Name
Affiliation
Email address
Contribution to the
project
Discipline
1
2
3
4
5
6
7
8
EXPLORE PROGRAM/LOI application form 2013
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CONFIDENTIAL
AMOUNT REQUESTED:
TITLE OF THE PROJECT:
[Comments]
CQDM FILE #:
[Keywords]
[Title]
SECTION 1. PROJECT SUMMARY (maximum 2 pages)
Define the following aspects of your project: rationale and hypothesis, background information, objectives, experimental approach
and research plan.
EXPLORE PROGRAM/LOI application form 2013
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CONFIDENTIAL
AMOUNT REQUESTED:
TITLE OF THE PROJECT:
[Comments]
CQDM FILE #:
[Keywords]
[Title]
SECTION 1. PROJECT SUMMARY (2/2)
EXPLORE PROGRAM/LOI application form 2013
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CONFIDENTIAL
AMOUNT REQUESTED:
TITLE OF THE PROJECT:
[Comments]
CQDM FILE #:
[Keywords]
[Title]
SECTION 2. IMPACT ON THE DRUG DISCOVERY/DEVELOPMENT PROCESS (Max 1 page)


Describe how the proposed research will address current challenges in the drug discovery and development process.
Discuss the following possible impacts (if applicable):
o Opening new therapeutic approaches and research avenues
o Bringing more effective medicines to the clinic and to the market
o Increasing the efficacy of existing drugs
o Reducing R&D costs, time to market or decreasing the risks of development
o Other impacts on the drug discovery and development process
EXPLORE PROGRAM/LOI application form 2013
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CONFIDENTIAL
AMOUNT REQUESTED:
TITLE OF THE PROJECT:
[Comments]
CQDM FILE #:
[Keywords]
[Title]
SECTION 3. INNOVATIVE CHARACTER OF THE TECHNOLOGY (Max 1/2 page)
Describe the novelty and the originality of the technical approach and explain how the proposed research represents a major
breakthrough, or could lead to a paradigm shift or seminal discovery
SECTION 4. POSITIONING AND INTERNATIONAL COMPETITIVENESS OF THE PROJECT (Max 1/2 page)

Describe how your technology or approach will bring added value to pharma when compared to already existing (or in
development) technologies.

Position your technology or approach relative to most current and powerful approaches or technologies that address the
same goals you are trying to achieve.
Describe in detail how your technology, approach or product is competitive at the local and international level focusing specifically
on the scientific aspects of the technology, approach or product and not on the excellence of the team or facilities
EXPLORE PROGRAM/LOI application form 2013
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CONFIDENTIAL
[Comments]
AMOUNT REQUESTED:
TITLE OF THE PROJECT:
CQDM FILE #:
[Keywords]
[Title]
SECTION 5. SIGNATURE OF PIs AND ALL CO-INVESTIGATORS (add pages, if necessary)
1. I authorize CQDM to exchange all information in relation to my file for evaluation purposes, under the
condition that the confidential character is respected by the individuals who are given access to this
information.
2. I obtained the agreement from all the co-investigators to participate in this research project.
Signature :
3. I certify that all information provided in this application is complete and accurate to the best of my
Name:
knowledge.
Signature :
Name:
Signature :
Name:
Signature :
Name:
SECTION 6. RESEARCH ENTITY’S SIGNATURE (add pages, if necessary)
1.
I certify that I am a signing officer of the research entity 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 basis equipment necessary for conducting this research project.
Signature :
Name:
Title :
Organization:
EXPLORE PROGRAM/LOI application form 2013
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