Western Economic Diversification Canada
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Western Innovation (WINN) Initiative Application

   HTML Version – For Reference Only (not for submission)

If you are unable to submit your application using the online application tool, contact a Western Economic Diversification Canada Regional Office for assistance.

Part Two
You will have approximately 15 business days to complete part two of this application once you receive the invitation. Before submitting this application, please ensure you have answered all questions that are applicable to your project. Unanswered questions cannot be assessed by Western Economic Diversification Canada.

Part One Confirmation
*63. Has any of the information you submitted in the Expression of Interest changed?
 
Project Costs
65a. Project Costs (All costs will be validated)* Amount *
  $
  $
  $
  $
  $
  $
  $
  $
Total Project Costs (Must equal total project funding required): $
* 65b. The following documents are required for WD to assess your submission. They must comply with the information requirements as outlined in the Applicant Guide. IT IS RECOMMENDED THAT YOU REVIEW THE APPLICANT GUIDE INSTRUCTION LOCATED AT http://www.wd-deo.gc.ca/eng/14794.asp#c1

   Financial Statements *
   Forecasted Income Statements and Cashflow*
 
Management
 
Technology Readiness Level
69a. Refer Back to the readiness level you chose in part 1.
  • Level 9 - Actual technology proven through successful deployment in an operational setting.
  • Level 8 - Actual technology completed and qualified through tests and demonstrations.
  • Level 7 - Prototype ready for demonstration in an appropriate operational environment.
  • Level 6 - System/subsystem model or prototype demonstration in a simulated environment.
  • Level 5 - Component and/or validation in a simulated environment.
  • Level 4 - Component and/or validation in a laboratory environment.
  • Level 3 - Analytical and experimental critical function and/or proof of concept.
  • Level 2 - Technology concept and/or application formulated.
  • Level 1 - Basic principles of concept are observed and reported.
69b.
70. If your organization answered “Yes” to question 52 please attach your written endorsement or review of the technology.
 
Project Timelines 71. Indicate project milestones that occur between the proposed project funding start date and the proposed project end date.
Milestone * Completion Date *
   
   
   
   
   
 
Market
* 73. If your organization answered “yes” to question 54, please attach your independent market assessment.
* 74.
 
Benefits
Complete all Amount
*
*
*
*

 
Technology Intellectual Property* From the list below, please select the choices that best reflect the patent status and patent ownership status of your technology, including other IP protection that applies.
* 77a.Select the response that best applies to the IP related to this project: (Select best fit)


* 77b.Patent Status in Canada: (Select best fit)



* 77c.Patent Status International: (Select best fit)


*77d.Other IP protection: (Select best fit)




* 78.
 
Technology
* 79.
* 80.
* 81.
* 82.

82a. You may attach a 1 page document to assist in this description (schematic, process diagram, design document etc.)
* 83.
* 84.
* 85.
*86.Does your project involve development and/or technology demonstration
If yes, answer the following three (3) questions.
* 86a.
* 86b.
* 86c.You may attach a 1 page document (Gantt chart) to help describe the plan. (The attachment cannot exceed 10MB in size.)
* 86d.
* 87.
 
Authorized Official of the Applicant Organization Acknowledgements

In reference to Part Two of this application:

On behalf of the Applicant Organization, I hereby acknowledge and agree that:

  • This application does not constitute a commitment from Western Economic Diversification Canada (WD) for financial assistance.
  • I have read the WINN application process including the mandatory eligibility criteria located at http://www.wd-deo.gc.ca/eng/14792.asp#a4.
  • Project costs incurred by the Applicant Organization in the absence of a signed funding agreement with WD are incurred at the sole risk of the Applicant Organization and that any such costs may not be considered eligible for WD assistance.
  • Any person who has been lobbying on behalf of the Applicant Organization to obtain a contribution as a result of this application is registered pursuant to the Lobbying Act and was registered pursuant to that Act at the time the lobbying occurred.
  • The Applicant Organization has not, nor has any other person, corporation or organization, directly or indirectly paid or agreed to pay any person to solicit a contribution arising as a result of this application for a commission, contingency fee or any other consideration dependent on the execution of an Agreement or the payment of any contribution arising as a result of this application.
  • The information provided by the applicant on this application and in all supporting documentation is collected under the authority of the Western Economic Diversification Act. This information will be treated in accordance with that Act and with the Access to Information Act and the Privacy Act. These laws govern, protect and limit the collection, use and disclosure of personal and confidential information by federal government departments and agencies. Information provided to WD is secured from unauthorized disclosure and use. WD acknowledges an individual's rights to privacy of their information, and personal information provided on this application is described in the Personal Information Bank entitled "Grants and Contributions (G&Cs) Programs", number WED-PPU-055.

    For further information about WD's information holdings and your rights under the Access to Information Act and Privacy Act, consult WD's Info Source publication at http://www.wd-deo.gc.ca/eng/14990.asp.

I authorize WD, its officials, employees, agents and contractors to make enquiries of such persons, firms, corporations, federal, provincial and municipal government departments/ agencies, and non-profit, economic development or other organizations as may be appropriate, and to collect and share information with them, as WD deems necessary in order to assess this application, to administer and monitor the implementation of the subject project, and to evaluate the results of the project and related Programs.

 

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*  Signature