Form SFN60452 "Research North Dakota Application" - North Dakota

What Is Form SFN60452?

This is a legal form that was released by the North Dakota Department of Commerce - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2018;
  • The latest edition provided by the North Dakota Department of Commerce;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN60452 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Commerce.

ADVERTISEMENT
ADVERTISEMENT

Download Form SFN60452 "Research North Dakota Application" - North Dakota

Download PDF

Fill PDF online

Rate (4.6 / 5) 48 votes
RESEARCH NORTH DAKOTA APPLICATION
NORTH DAKOTA DEPARTMENT OF COMMERCE
SFN 60452 (1-18)
1. Type of Submission
Research ND
Research ND BIO
FAST Track
Venture Grant Phase
Venture Grant Phase II
Venture Grant Past I\II
Title of Application
Date Submitted
Proposed Project Starting Date (MM/DD/YY)
Proposed Project Ending Date (MM/DD/YY)
2. Funding
Requested State Funds
Private Sector Cash to Center
Private Sector Cash Reserved
Total Project Cost
3. Research University
Name
DUNS
EIN
Mailing Address
City
State
ZIP Code
4. Principal Investigator (Research University)
Name
Degree(s)
Position/Title
Department
Mailing Address
City
State
ZIP Code
Major Subdivision
E-mail Address (required)
Telephone Number (required)
Fax Number
5. Administrative Official to be Notified if Award is Made
Name
Degree(s)
Mailing Address
City
State
ZIP Code
Telephone Number (required)
Fax Number
E-mail (required)
6. Official Signing for Research University
Name
Degree(s)
Mailing Address
City
State
ZIP Code
Telephone Number (required)
Fax Number
E-mail (required)
APPLICANT ORGANIZATION CERTIFICATION AND ACCEPTANCE: I certify that the statements herein are true, complete and accurate to the best of
my knowledge, and accept the obligation to comply with the Research North Dakota terms and conditions if a grant is awarded as a result of this
application. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties.
Signature
Date
RESEARCH NORTH DAKOTA APPLICATION
NORTH DAKOTA DEPARTMENT OF COMMERCE
SFN 60452 (1-18)
1. Type of Submission
Research ND
Research ND BIO
FAST Track
Venture Grant Phase
Venture Grant Phase II
Venture Grant Past I\II
Title of Application
Date Submitted
Proposed Project Starting Date (MM/DD/YY)
Proposed Project Ending Date (MM/DD/YY)
2. Funding
Requested State Funds
Private Sector Cash to Center
Private Sector Cash Reserved
Total Project Cost
3. Research University
Name
DUNS
EIN
Mailing Address
City
State
ZIP Code
4. Principal Investigator (Research University)
Name
Degree(s)
Position/Title
Department
Mailing Address
City
State
ZIP Code
Major Subdivision
E-mail Address (required)
Telephone Number (required)
Fax Number
5. Administrative Official to be Notified if Award is Made
Name
Degree(s)
Mailing Address
City
State
ZIP Code
Telephone Number (required)
Fax Number
E-mail (required)
6. Official Signing for Research University
Name
Degree(s)
Mailing Address
City
State
ZIP Code
Telephone Number (required)
Fax Number
E-mail (required)
APPLICANT ORGANIZATION CERTIFICATION AND ACCEPTANCE: I certify that the statements herein are true, complete and accurate to the best of
my knowledge, and accept the obligation to comply with the Research North Dakota terms and conditions if a grant is awarded as a result of this
application. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties.
Signature
Date
SFN 60452 (1-18)
Page 2 of 11
7. Private Sector Partner
Company Name
DUNS
EIN
Mailing Address
City
State
ZIP Code
Is the Private Sector Partner registered
Does the Private Sector Partner meet
with the ND Secretary of State’s Office?
the definition of “substantial presence”?
Yes
No
Yes
No
8. Project Director (Private Sector)
Name
Degree(s)
Position/Title
Department
Mailing Address
City
State
ZIP Code
Major Subdivision
E-mail Address (required)
Telephone Number (required)
Fax Number
9. Official Signing for Private Sector
Name
Title
Mailing Address
City
State
ZIP Code
Telephone Number (required)
Fax Number
E-mail (Required)
APPLICANT ORGANIZATION CERTIFICATION AND ACCEPTANCE: I certify that the statements herein are true, complete and accurate to the best of my
knowledge, and accept the obligation to comply with the Research North Dakota terms and conditions if a grant is awarded as a result of this application. I am
aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties.
Signature
Date
10. Abstract
A self-contained description of the project for dissemination to the public. Must not include any proprietary/confidential information.
SFN 60452 (1-18)
Page 3 of 11
11. Checklist (Research University)
Are Human Subjects Involved?
Yes
No
If YES, is the project EXEMPT from Federal Regulations?
Yes
No
If EXEMPT, check the appropriate Exemption Number
1
2
3
4
5
6
If no EXEMPT, is the IRB Review Pending?
Yes
No
Human Subjects Assurance Number:
Is this a biomedical or behavioral research study involving drugs, treatments, devices, or new ways of using known
Yes
No
drugs, treatments or devices?
If YES, will the requested funds be used for a clinical trial?
Yes
No
If YES, which phase?
I
II
III
IV
Are vertebrate animals used?
Yes
No
If YES, is UACUC Approval Pending?
Yes
No
Animal Welfare Assurance Number:
Is approval pending for all other required compliance activities (e.g. select agents, export control, radiation safety)?
Yes
No
Is proprietary/privileged information included in this application?
Yes
No
Yes
No
If YES, indicate if you have red the instructions for Section 16. Confidential Information, understand the type of information that is covered
under N.D.C.C.
§ 44-04-18.4, and have only included proprietary/privileged information in Section sixteen (16) of the application.
12. Checklist (Private Sector Partner)
Has a Private Sector Partner been identified in Section 7 of the application?
Yes
No
Are Human Subjects Involved?
Yes
No
If YES, is the project EXEMPT from Federal Regulations?
Yes
No
If EXEMPT, check the appropriate Exemption Number
1
2
3
4
5
6
If no EXEMPT, is the IRB Review Pending?
Yes
No
Human Subjects Assurance Number:
Is this a biomedical or behavioral research study involving drugs, treatments, devices, or new ways of using known
Yes
No
drugs, treatments or devices?
If YES, will the requested funds be used for a clinical trial?
Yes
No
If YES, which phase?
I
II
III
IV
Are vertebrate animals used?
Yes
No
If YES, is UACUC Approval Pending?
Yes
No
Animal Welfare Assurance Number:
Is approval pending for all other required compliance activities (e.g. select agents, export control, radiation safety)?
Yes
No
Is proprietary/privileged information included in this application?
Yes
No
Yes
No
If YES, indicate if you have red the instructions for Section 16. Confidential Information, understand the type of information that is covered
under N.D.C.C.
§ 44-04-18.4, and have only included proprietary/privileged information in Section sixteen (16) of the application.
SFN 60452 (1-18)
Page 4 of 11
Supply Sections 13-16 as a separate Word or PDF file.
13. Project Description
Research ND/Research ND BIO/FAST Track applications should contain the following:
Justification: State concisely the goals of the proposed research and summarize the expected outcome(s). Include the
impact that the results of the proposed research will have as it relates to research, development and commercialization
of a product or process for the Private Sector Partner (PSP).
List succinctly the specific objectives of the research proposed in this application including milestones. Specific
objectives may include but are not limited to: create a novel design, solve a specific problem, challenge an existing
paradigm or clinical practice, address a critical barrier to progress in the field, or develop new technology.
The Justification section is limited to one (1) page.
Project Description: A detailed description of the project including: objectives, expected results and techniques. Include
in this section a project management plan, including a well-defined milestone chart, schedule, and plan for
communication between research university investigators and the PSP. Include information about how each objective
relates to the project's significance as outlined in the justification portion of the application.
The project description is limited to eleven (11) pages.
Venture Grant Phase I, II and I/II applications should contain the following:
Executive Summary: One page or less describing the overall objectives, technological developments to date, market
needs, and a summary of the expected outcomes of the current proposal.
Project Description: A detailed description of the project including: objectives, expected results and techniques. Include
in this section a project management plan with a well-defined milestone chart. Include information about how each
objective relates to the project's significance as outlined in the justification portion of the application.
The project description is limited to ten (10) pages.
Market Analysis: The Market Analysis is limited to three (3) pages and should include the following:
1. A frank assessment of the technology's state of development and an estimate of the development time required
to reach a 'market ready' technology/product.
2. A review of the competitive landscape comparing the current market with the 'technology' outlined in this
proposal.
3. A description of the current need in the marketplace and the anticipated target market. Specific descriptions of the
target market and quantitative estimates of the market size are key elements of a compelling proposal.
4. Every new venture will face a unique set of challenges and obstacles to success. A description of the challenges
that the business will face in bringing its technology to market will demonstrate an understanding and appreciation
for the challenges ahead.
5. A predicted timeframe to the launch of a business and time to profitability.
Results from previous Venture Grant projects (Phases II applications only): If previous Venture Grant funding was
awarded to a company, a clear outline of how those funds were effectively used must be included. Specific results
backed by quantitative data provide compelling evidence of success.
The Results section should be limited to two (2) pages.
SFN 60452 (1-18)
11
Page 5 of
Supply Sections 13-16 as a separate Word or PDF file.
14.
Technologic and Economic Impacts to the Private Sector Partner (to be completed by the Private Sector Partner)
Section 14 of the application is subject to open records requests. Do not include proprietary or other confidential information.
Describe the expected benefit to North Dakota. Explain how the proposed project will benefit the PSP in the areas of technologic
improvements to new or existing products or the expected economic impacts of the project. If necessary to fully explain the
technologic or economic impacts of the proposed project, confidential or proprietary information can be included in Section 16 of
the application but this is discouraged.
The PSP should describe how they will measure the success of this project. Methods of measuring success may include, but
are not limited to: introduction of new products or services, job creation in North Dakota, new businesses or expansion of
existing businesses in North Dakota, growth of market share or increase of profits for the PSP (either through new efficiencies
or the creation of a new product or service), opportunities for new or existing manufacturers in North Dakota, or other
anticipated economic impacts.
The Technologic and Economic Impacts to the PSP is limited to two (2) pages.
15.
Technologic and Economic Impacts to the Research University (to be completed by the Research University)
Section 15 of the application is subject to open records requests. Do not include proprietary or other confidential information.
The
Research University should describe how they will measure the success of this project. These may include developing the
university’s reputation as a thought leader in a particular discipline, development of IP that is commercialized, real world training
for students, or other anticipated economic impacts.
The Technologic and Economic Impacts to the Research University section is limited to two (2) pages.
16.
Confidential Information
Patentable ideas, trade secrets, privileged or confidential commercial or financial information, disclosure of which may harm
the applicant, should be included in applications only when such information is necessary to convey an understanding of
the proposed project. If the application includes such information, it is necessary to include this information only in this
section of the application.
If confidential information is included in the application, it is the applicant’s responsibility to ensure that such information
conforms to the definitions of confidential/proprietary information in N.D.C.C. § 44-04-18.4. The inclusion of materials other than
those protected by N.D.C.C. § 44-04-18.4 in this section of the application will negate any protection offered by
N.D.C.C. § 44-04-18.4.