CLIC Application Form

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Name of your team *

Provide a short description of your project proposal that will be made public (maximum 500 characters) *

Who is the lead contact for your team

Name *

Primary Title *

Department/Institution *

E-mail *

Phone Number *

Who is the alternate lead contact for your team

Name *

Primary Title *

Department/Institution *

E-mail *

Phone Number *

3rd Member of your Team (if applicable)

Name

Primary Title

Department/Institution

E-mail

Phone Number

4th Member of your Team (if applicable)

Name

Primary Title

Department/Institution

E-mail

Phone Number

5th Member of your Team (if applicable)

Name

Primary Title

Department/Institution

E-mail

Phone Number

6th Member of your Team (if applicable)

Name

Primary Title

Department/Institution

E-mail

Phone Number

7th Member of your Team (if applicable)

Name

Primary Title

Department/Institution

E-mail

Phone Number

8th Member of your Team (if applicable)

Name

Primary Title

Department/Institution

E-mail

Phone Number

CURRENT FUNDING

Are you currently funded? *

Yes

Current Funding - Details

Please specify details

OTHER COMPETITIONS & AWARDS

Have you won other competitions or awards? *

Yes

Other Competitions & Awards - Details

Please specify details and dates

ENTERPRISE INCORPORATION

Is your enterprise currently incorporated? *

Yes

Enterprise Incorporation - Details

Please provide incorporation name and registration number, as well as date of incorporation

SALES

Have you had sales over the last 5 years? *

Yes

Sales - Details

Please indicate the amount of sales/year

INTELLECTUAL PROPERTY

Do you have any current or pending Intellectual Property patents, copyrights or trademarks? *

Yes

Intellectual Property - Details

List any current or pending Intellectual Property patents, copyrights or trademarks

PROPOSAL FILE ATTACHMENT

Please note that your proposal document should be in PDF format, must not exceed 10 pages, must not exceed 10 MB in size, and must adhere to the following criteria outlined in the guidelines.

Important: Before uploading, please name your file using the following convention:聽 clic_your_team_name.pdf

If you experience any difficulties when submitting your proposal, please contact innovation.med [at] mcgill.ca.

Please attach your proposal

Files must be less than 10 MB.
Allowed file types: pdf.

Leave this field blank

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CLIC Application Form

Department and University Information

Faculty of Medicine and Health Sciences