Israel-Canada Collaborative Industry R&D ProgramExpression of Interest Form
1. Project Participant
Company name: __________________
Website: ________________________
Year established: _________________
Type of company: __R&D __ Research institute __ University __ Other
Stage: __ R&D __ Initial revenues __ Revenue growth
Ownership: __ Public __ Private __ Governmental __ Other
Number of employees: ____
Number of R&D personnel: ____
Company contact information:
Address: __________________________________________________.
Contact person:
Name: _________________________
Title: __________________________
Phone: ________________________
Mobile: ________________________
Email: _________________________
2. Organization Background
General Business Description & Area of Expertise
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Technology Description (Main Products/Services) and IP
Targeted Customers
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Sales (over the last 3 years)
Current year: ________________
Year-1 _________________________
Year-2 ________________________
3. General Information
Project Title: ________________________________________________________
Technology Sector:
________________________________________________________
Submission Date: __/__/____
Summary:
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Project Start Date: __/__/____
Project End Date: __/__/____
4. Budget:
Total Project Budget: __________________________
Requested Grant (% of budget): _________________________
5. Project Outline:
Project Description Including Level of Innovation
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Market Potential and Commercialization Plan
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Expected Outcome of Project
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Short Profile of the Key Staff who will be Undertaking the Work ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
