JPI-EC-AMR Joint Transnational Call for Proposals Pre-proposal application form

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1 JPI-EC-AMR JTC 08 Pre-proposal application form JPI-EC-AMR Joint Transnational Call for Proposals 08 Innovation against antibiotic-resistant bacteria: new targets, compounds and tools Fundamental and translationalresearch, with the exception of clinical trials. Pre-proposal application form CHECKLIST FOR THE COORDINATOR: In order to make sure that your proposal will be eligible to this call, please collect the information required to tick all the sections below before starting to complete this application form. - General conditions: The project proposal addresses the AIM(S) of the call The project proposal meets the TOPIC(S) included in this call - The composition of the consortium: The project proposal involves at least eligible research partners from at least different countries participating in the call. The project proposal does not include more than or eligible research partners funded by the same funding organisation. Please note that for Italy, there may be only one participant per project, where as for the other participant countries, there may be up to eligible partners per project. For Belgium, this is limited to one partner per region/community, which in practice comes down to one partner per participating Belgian funding agency. The consortium coordinator is eligible to receive funding from the funding organisations participating in the call. There are not more than partners who secure their own funding and contribute substantially to the work packages present in the consortium. The coordinator and the majority of the partners in a consortium must be eligible for the funding organisations participating in the call. The budget of a non-funded partner shall not exceed 0% of total transnational project budget requested. The project proposal involves a maximum of 6 or 7 eligible research partners asking for funding. In case of inclusion of partners from Czech Republic, Egypt, Latvia, Poland or Romania the project involves a maximum of 7 eligible partners. Otherwise, projects may only include 6 eligible research partners. Partners not asking for funding must also be noted in the project proposal. The number of partners not requesting funding may not exceed two per project proposal. Number of partners requesting funding (eligible partners) (only with at least a partner from Czech Republic, Egypt, Latvia, Poland or Romania) 7 (only with at least a partner from Czech Republic, Egypt, Latvia, Poland or Romania) Maximum number of additional partners with own funding 0 0

2 JPI-EC-AMR JTC 08 Pre-proposal application form - Eligibility of consortium partners: I have checked that each partner involved in the project proposal is eligible to receive funding by its funding agency. Non eligible partners are therefore aware of that fact and a signed statement declaring that they will run the project with their own resources is enclosed in the proposal. (if applicable) Italian partners involved in the proposal have submitted a pre-submission eligibility check form to their national funding organization at least 7 working days before the submission deadline. Please note: Proposals that do not meet the national eligibility criteria and requirements will be declined without further review. All fields must be completed using Arial, single-spaced, margins of.7 cm. Incomplete proposals, proposals using a different format or exceeding length limitations of any sections will be rejected without further review. Please remove instructions in the final application. Once completed the pre-proposal must be converted in a single PDF document before being uploaded to the submission website. In case of inconsistency between the information registered in the submission tool and the information included in the PDF of this application form, the information registered in the submission tool shall prevail..a Project Title: (max. 50 characters including blanks).b Project acronym: (max. 0 characters). Consortium coordinator (Partner ): Family Name, first Name Institution/Department Department Position Address Zip/postal code Town Phone Fax address Academia, Clinical or Public Health, SME and Industry Status (public/private-forprofit/private-non-for-profit). Research Partners: a. Research partners asking for funding:

3 JPI-EC-AMR JTC 08 Pre-proposal application form Zip code, City, Research Partner (principal investigator) (only possible with inclusion of Czech Republic, Egypt, Latvia, Poland or Romania) Institution, Department, full affiliations (address, phone + fax) address Academia, Clinical or Public Health, SME and Industry (public/privateforprofit/privatenon-for-profit) b. Associated research partners not asking for funding: Zip code, City, Research Partner (principal investigator) Institution, Department, full affiliations (address, phone + fax) address Type of entity Academia, Clinical or Public Health, SME and Industry (public/privateforprofit/privatenon-for-profit) 4. Duration of the project (max. 6 months): 5. Total funding applied for: 6. Keywords Identify between three and seven keywords that represent the scientific content. 7. Scientific area Choose one or more scientific area(s) relevant to your project: New targets New therapies New tools/assays 8. Abstract (max. 600 characters including spaces) 9. Description of the project (once converted into Pdf document: max. 5 pages DIN-A4, Arial, singlespaced, margins of.7 cm). Description of the working programme including: background, present state of the art and preliminary results obtained by the consortium members; objectives, the rationale, the methodology highlighting the novelty, originality and feasibility; description of the unmet medical and patient need that is addressed by the proposed work and the potential health impact that the results of your proposed work will have; added value of the transnational collaboration. ethical considerations

4 JPI-EC-AMR JTC 08 Pre-proposal application form 0. Diagrams of the work plan, timeline, work flow and interconnections of work packages (Gantt chart, Pert or similar, max. page).. In addition, two more pages can be added to the pre-proposal (optional): a list of references (max. page) a page of diagrams, figures, etc. to support the work plan description (max. page). Budget table (see last page for template). Brief CV for each principal investigator (once converted into Pdf document: max. page DIN-A4, Arial, single-spaced, margins of.7 cm per principal investigator) Brief CV for each principal investigator including a description of the main domain of research and a list of the 5 most relevant publications within last five years regarding the proposal. 4. Date and signature of the coordinator 4

5 . Budget plan of the project (only requested budget) Acronym: Funding organization Personnel Consumables Equipment Travel Other direct costs Partner (Project coordinator) Partner Partner Partner 4 Partner 5 Partner 6 Partner 7 (only possible with inclusion of Czech Republic, Egypt, Latvia, Poland or Romania) Overheads Total requested budget of the project Travel expenses should include the participation to intermediate and final status symposia which will be organized by the Joint Call Secretariat e.g. subcontracting, provisions, licensing fees; may not be eligible costs in all countries (will be handled according national regulations) Overhead costs and eligible expenses: funding according to national legal framework and funding body regulations Applicants are encouraged to confirm their eligibility with their national contact points. 5

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