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ESTHER Switzerland Start-Up Fund
2017 Application Form
Proposal N°
Please leave this void, it will be filled by the ESTHER Secretariat
PROPOSAL
AT A GLANCE
Project Title
Country Country of the partner institution
Goal max 3 lines
Swiss institution NameAddressName, position and contact detail (e-mail, phone) of the contact person
Partner institution(s) NameAddressName, position and contact detail (e-mail, phone) of the contact person
Requested grant (CHF)(max. CHF 10’000.--)
Timeframe
N.B.: Please provide as an attachment short resume of applicants’ professional experience (relevant to the
application) Please read the document “Guidelines for submission of proposals, 2017” and write your proposal
accordingly.
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1 Proposal for development of institutional partnership(Please provide a clear description of the propose project: what do you propose to do? What do you want to achieve?)
2 History of development of institutional link(Please provide a description of the institutional link: is the proposed partnership new? It already exist in some form? Etc.)
3 Justification– how this institutional health partnership will contribute to improved health / health care.
4 Evidence of interest and commitment of Swiss and Southern institutions (ex. Letter of intent)
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5 How grant funds will be used to develop partnership
6 How Swiss institution will manage the funding and development of the partnership
8 Budget details (incl. other financing sources)(if necessary, provide a separate document)
9 Additional information: please provide any additional information that could help to a clear understanding of the project.
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10 Next Steps: what do you plan to do after this exploratory project is concluded?
Signature: ______________________________________ (electronic signature for email applications)
Name: ______________________________________
Position: ______________________________________
Date: _________________
Completed and signed proposal form should be submitted by e-mail and normal mail to the ESTHER Switzerland Secretariat:
Luciano RuggiaSecretariat ESTHER SwitzerlandInstitute of Social and Preventive MedicineUniversity of BernFinkenhubelweg 113012 BernTel. +41 22 372 96 58E-mail: [email protected]
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