UCeed Health Growth Fund Application Form

Name(Required)
Prefix First Last
Title(Required)
Phone Number(Required)
Email(Required)
Street Address(Required)
City(Required)
Country(Required)
Postal Code(Required)
LinkedIn Profile
Affiliation with UCalgary(Required)
- Student
- Faculty
- Other
If other, please specify.

Co-founders. Please state names, roles and affiliations with UCalgary, in addition to the primary contact person.(Required)
Number of Employees. Full-time equivalent including founders.(Required)
What role does each individual play on your team, including leading the development of the venture's core technology?(Required)
What are the three most relevant areas of expertise on your team?(Required)
If your venture has a Board, Advisory Board, or mentors, please list their names and their roles.(Required)
Have you or any member of your team successfully commercialized a technology or founded a company? If so, please describe.(Required)

Do not include confidential information about the technology.
Describe your core technology in non-technical terms.(Required)
What areas of science does your technology draw from?(Required)
What is novel about your technology?(Required)
What are the primary technical challenges that need to be overcome with your technology?(Required)
Do you have any Intellectual Property in place or filed? If yes, please describe and/or cite any patent number filings. If no, enter N/A.(Required)
List all grants and research funding that have been provided in support of this technology's development.
List all publications by the team on which your technology is based.
Has the research on which your technology is based been replicated by another researcher or third party?
List all significant collaborations with other labs/universities that exist for the development of this technology.(Required)
Which of the following best describes your current Technology Readiness Level (TRL)?
- Level 1: Basic principles of concept are observed and reported
- Level 2: Technology concept and/or application formulated
- Level 3: Analytical and experimental critical function and/or proof of concept
- Level 4: Component and/or validation in a laboratory environment
- Level 5: Component and/or validation in a simulated environment
- Level 6: System/subsystem model or prototype demonstration in a simulated environment
- Level 7: Prototype ready demonstration in an appropriate operational environment
- Level 8: Actual technology completed and qualified through tests and demonstrations
- Level 9: Actual technology proven through successful deployment in an operational setting
NOTE: The following questions are required for all TRL6 applicants (optional for less than TRL6)
Please list any government funding, in-kind contributions or program support that you have received for this venture.
Describe how much has been invested into the venture (investment in dollars in exchange for shares) and describe the relationship of the investors to the company (friends/family/3rd party)?
Describe how much has been invested into the venture (investment in dollars in exchange for shares) and describe the relationship of the investors to the company (friends/family/3rd party)?
Have you generated any revenue to date? If yes, please describe. If no, enter N/A.
Do you have interest/engagement of a potential customer or commercial development partner? If yes, please describe. If no, enter N/A.
Please describe your plan and timelines to execute and grow?
Have you considered an exit strategy and if so, what does this look like?

What problem is your technology product solving?(Required)
Explain how your technology/product solves the problem described above and why it is, or could be, superior to existing alternatives?(Required)
What market(s) are you targeting and what is the size of the market?(Required)
Who are your main competitors and why?(Required)
Does your proposed venture have health and wellness applications for the following? Select all that apply.
- Maternal (including pregnancy, childbirth, and postpartum)
- Infant
- Child
- Adolescent
- Emerging adult (up to the age of 24)
If you selected any of the applications in Question 5, provide the following information for each of the applicable options. For example, if your venture has applications to both maternal and infant health and wellness, you need to complete Question 6 for each area.
Please describe the following for each of the application populations based on your response from Question 5.
The nature of the application.
The degree of anticipated impact.
How UCeed support can accelerate that impact?
How proven and ready for use is the research and applicability as proposed, and what are the remaining steps to commercial release?
The initial and medium-term potential markets and monetization opportunities.
Are you a past or current recipient of research funding from ACHF and/or ACHRI?
- Yes
- No
If yes, has/will that funding enable(d), fully or partially, the work proposed as part of this application? If yes, please describe.
Are you a past or current recipient of research funding from other child health/disease-based funding agencies? If yes, please name sources of funding.

How much money are you asking to raise from UCeed?
What is/are the major technology and/or business milestone(s) that you are trying to achieve with these funds?
Specifically, how will these funds be used in pursuit of this goal and how long will it take to achieve?

How can Innovate Calgary help your venture succeed?
Is there anything else you would like to tell us?
Please list any materials (e.g. patents, publications, market reports) or other documents (e.g. resume, product design, etc.) that you fell would strengthen your application.
Privacy Notice(Required)
Privacy Notice: Personal information collected in connection with your application to UCeed, including data collected from the venture’s founders and its employees such as contact information, education history, work experience, and financial information about the venture, will be used for the purposes of processing and responding to your application, including assessing the suitability of your venture for funding. UTI Limited Partnership (“ULP”) as an organization has a policy against sharing any sensitive technical information or intellectual property relating to the venture with any researchers that are not connected to the venture. If you provide ULP with personal information about any other individual (such as your co-founder(s) or partner(s) in the venture), you confirm that you have obtained the consent of such individual(s) prior to providing any personal information to ULP. ULP will also use this information (in addition to information about your participation in the program, if accepted) for internal research and analysis in order to identify, evaluate and better understand factors that contribute to a successful venture. ULP may also share de-identified data with third-party academic researchers for social science research purposes.(Required)
ULP's Business Notice
Notice about ULP's Business: ULP is the innovation transfer and business incubator centre of the University of Calgary, and as such, ULP commercializes a wide variety of intellectual property and technologies, owns equity positions in various companies, assists start-up companies and entrepreneurs, and provides business incubation services. Therefore, you acknowledge and agree that: (a) ULP may, now or in the future, work directly or indirectly with individuals and businesses that are commercializing intellectual property and/or technologies that could compete with your venture or operate in similar fields as your venture; (b) ULP may, now or in the future, own equity in companies that are commercializing intellectual property and/or technologies that could compete with your venture or operate in similar fields as your venture; and (c) none of the information that you provide to ULP in connection with your UCeed application will hinder or restrict ULP in the conduct of its business.
Email
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UCeed Health Growth Fund Application Form

Do not include confidential information about the technology.

NOTE: The following questions are required for all TRL6 applicants (optional for less than TRL6)

If you selected any of the applications in Question 5, provide the following information for each of the applicable options. For example, if your venture has applications to both maternal and infant health and wellness, you need to complete Question 6 for each area.

Please describe the following for each of the application populations based on your response from Question 5.

The following questions are required for all Stages of Ventures listed as prototype or beyond (Levels III - VI).

UCeed Health Growth
Fund Application Form