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Genomic Applications Partnership ProgramExpression of Interest

GENERAL INSTRUCTIONS Please delete this page before submitting the Expression of Interest (EOI).All Expressions of Interest (EOI) must be submitted to Genome Canada through a Genome Centre; EOIs submitted directly to Genome Canada will not be accepted. Please contact your regional Genome Centre immediately for further information on their process. EOIs will be accepted on a rolling intake basis on or after July 29, 2013. Please refer to the Genomic Applications Partnership Program (GAPP) Investment Strategy and Guidelines for more details. At the time of submission of an EOI, Genome Centres must submit the following to Genome Canada: One (1) electronic copy of the EOI in PDF format. The file should be labelled using the last names of the Academic and User Project Leaders (format: Smith, Johnson). Signatures must not be included in this document. One (1) electronic copy of Appendix 1 - Co-funding Plan in Excel format. One (1) electronic copy of the signature pages of the application signed and completed. Electronic signatures are acceptable.

The EOI form is free-form, but must include each of the section headings as set out in the form and address the points indicated below the headings. Type must be single-spaced, with top and bottom margins of a minimum of 1.7cm and left and right margins of a minimum of 2.5 cm. Type font Arial, 11 point must be used. Page limits will be strictly enforced; any excess material will be removed and not taken into consideration.

MEANING OF SIGNATURESThe signatures of the Academic and User Project Leader(s), as well as authorized representative(s) of the Academic Institution, User Organization and the Genome Centre(s) confirm that this EOI has been reviewed and approved for submission to Genome Canada.

LANGUAGE OF APPLICATIONThe Investment Strategy and Guidelines are provided in both official languages; however, to ensure that EOIs can be evaluated by the most appropriate reviewers, all applications must be submitted in English.

Genomic Applications Partnership ProgramExpression of Interest

Project Title:

Estimated Total Budget:

Amount Requested from Genome Canada (max 1/3 of Total Budget):

Project Duration:

Academic Project LeaderUser Project Leader

Name[footnoteRef:1] [1: The Academic Project Leader assumes the administrative and financial responsibility for the project funds that will be paid to his/her institution.]

Name[footnoteRef:2] [2: The User Project Leader assumes the administrative and financial responsibility for the project expenses incurred within their organization.]

Affiliation Affiliation

Address

Address

Telephone Telephone

E-mailE-mail

DateDate

Signature[footnoteRef:3] [3: Signatures confirm acceptance of terms as outlined in the Meaning of Signatures]

Signature3

Academic Institution

User Organization

Name[footnoteRef:4] [4: The EOI must be signed by an authorized representative of the Academic Institution or Not-for-Profit Organization.]

Name[footnoteRef:5] [5: The EOI must be signed by a senior representative of the User Organization who has the authority to confirm the financial co-funding contribution provided by the User organization to the project.]

Affiliation Affiliation

Address

Address

Telephone Telephone

E-mailE-mail

DateDate

Signature3

Signature3

Genome Centre CEO(s) or authorized representativeLead Centre Co-lead Centre (if applicable)

Name Name

DateDate

Signature3Signature3

Additional Centre (if applicable)

Name

Date

Signature3

SECTORS IMPACTED AND KEY WORDS

Select the area(s) that relate(s) to the research proposed. If relevant to more than one area, use numbers to indicate the relative weighting (i.e., 1 = primary focus; 2 = secondary focus, etc.)

AgricultureEnergyEnvironment

FisheriesForestry

Human HealthMining

Provide a maximum of ten (10) key words that describe the projects methods and deliverables.

User Need (maximum 1 page)

Describe the key challenge or opportunity as defined by the User and the potential of a genomics-derived solution to address the need or opportunity. Explain how this product or service is integral to the users objectives and strategy.Project Plan (maximum 2 pages)Outline the plan for carrying out the project, including: the project objectives; a description of the Academic and the User and their roles in the project a description of how the partnership is structured and how it leverages the resources and expertise of the partners a description of the product, tool or process to be developed, validated or enhanced and its current stage of development; and, Benefits to Canada (maximum 2 pages)Describe, with supporting evidence: the deliverables to be realized by the end of the project; the market potential, or other measurable impact, for the product, tool or process to be developed, validated or enhanced; who will benefit from the project, including how the deliverables will benefit the User; the unique advantages the product, tool or process will deliver; the plan for exploiting the results of the project for the socio-economic benefit of Canada in the near term (within 3-5 years of project completion), including a summary of the commercialization/translation strategy, or other strategies to ensure uptake into policy or practice; the plans for handling IP, if applicable; and, the Users ability to deliver on the plan to exploit the results of the project.Other (maximum 1 page)If this is a resubmission of a project previously submitted to the GAPP, please provide details of the key differences between that application and the current proposal.

Appendix 1. Co-funding PlanUsing the excel template provided, provide a co-funding plan.