EUREKA FORM FOR CLUSTERS Filling in of the yellow boxes is not mandatory when requesting the "Applicant Label". At the end of the definition phase, the yellow boxes must be completed in order to get the Definite EUREKA Label. 1. GENERAL INFORMATION 1.1 Acronym 1.2 Title 1.3 Summary 1.4 Main EUREKA Technological Area Electronics, IT Telecommunications 1.5 Estimated Budget (Total costs of projects planned) and Duration Budget (Mio ) Duration (months) Definition Phase (max. 18 months) Implementation Phase Total 0.00 0 1.6 Start date End date 1.7 Main Country Country Contribution (%) Page 1 of 10
1.8 Member Countries (at least 5 including the main country) Country Contribution (%) total 1.9 Partner sought Yes No Remarks 2. RATIONALE AND VISION (Detailed objectives and work programme to be described in the White Paper) 2.1 Description (approximately one A4 page) 2.2 Technological domains envisaged in generated projects (Summary of Technology Roadmap) 2.3 Market and implementations domains envisaged in generated projects Page 2 of 10
3. CLUSTER MAIN PARTICIPANT OR CHAIR 3.1 Organisation name Full name Parent organisation 3.2 Organisation address / switchboard Street Postal code Province (region) Tel 3.3 Main participant or Chair person data Function Direct telephone Email Nr. City Country Title 3.4 Website URL 3.5 Organisation identification codes Nace codes (SIC 92) Type of organisation Large company SME University Research institute Administration or other 3.6 Contribution to the Cluster 3.7 Expertise Page 3 of 10
4. CLUSTER OFFICE 4.1 Organisation name Full name Parent organisation 4.2 Organisation address / switchboard Street Postal code Province (region) Tel Nr. City Country 4.3 Contact person data (office director) Function Direct telephone Email Title 4.4 Website URL 4.5 Organisation identification codes Nace codes (SIC 92) Type of organisation Large company SME University Research institute Administration or other 4.6 Contribution to the Cluster 4.7 Expertise Page 4 of 10
5. OTHER PARTICIPANTS (participants active in the Cluster Board, Steering Committee or in any other official Cluster body, for public authorities see annex; each participant has to fill in one other participants form) 5.1 Organisation name Full name Parent organisation Role in the Cluster Specify Cluster body, e.g. Board, Steering Committee 5.2 Organisation address / switchboard Street Postal code Province (region) Tel Nr. City Country 5.3 Contact person data Function Direct telephone Email Title 5.4 Website URL 5.5 Organisation identification codes Nace codes (SIC 92) Type of organisation Large company SME University Research institute Administration or other 5.6 Contribution to the Cluster 5.7 Expertise 6. CLUSTER IDENTIFICATION CODES 6.1 Keywords Page 5 of 10
7. RELATIONSHIP WITH OTHER R & D PROGRAMMES 7.1 Is the Cluster related to any regional programme(s)? yes no 7.1.1 If yes, please indicate the programme(s) and specify which actions are planned with respect to them. 7.2 Is the Cluster related to any national programme(s)? yes no 7.2.1 If yes, please indicate the programme(s) and specify which actions are planned with respect to them. 7.3 Is the Cluster related to any other European programme(s), such as COST, European Technology Platforms, JTI, etc.? 7.3.1 If yes, please indicate the programme(s) and specify which actions are planned with respect to them. yes no Remarks Page 6 of 10
To obtain EUREKA status the form must be co-signed by at least five participants from different EUREKA member countries, before the meeting of the EUREKA High Level Group in which the assignment of EUREKA status to the Cluster will be discussed. According to the Cluster Guidelines, the Applicant EUREKA Label will be granted for a a period of maximum of 1.5 years for the definition & feasibility and for securing the financing of the Cluster s running costs and projects. The definite EUREKA Label will be given for the full project phase, provided that the outcome of the definition & feasibility phase is positive in all aspects, in particular including the financial arrangements. When a Cluster already obtained EUREKA status, other interested organisations can officially be recognised as participants when they satisfy EUREKA criteria and after they have co-signed this form. The participants signing below declare their intention to co-operate within the Cluster as described in this form with the aim of realizing the technical developments as set forth under point 2 and formally apply for EUREKA status to be applied to this Cluster. In addition the participants have or intend to put in place, a formal collaboration agreement. They undertake to provide their respective National EUREKA Office with updates of this form whenever significant change occurs, or at least once a year as well as a brief final report when finishing the Cluster, as stated in the Cluster Guidelines. They also agree to provide information on the progress of the Cluster to the EUREKA network on a periodic basis. They agree to include in any PR material related to the Cluster, the EUREKA logo, the EUREKA number and acronym of the Cluster. Furthermore, the participants confirm that they acknowledge the EUREKA Cluster Guidelines. Page 7 of 10
Co-signature of Cluster Main participant or Chair Organisation full name Name of PERSON signing Function in organisation Signature It is not possible to sign this form electronically! Co-signature of Cluster Office Organisation full name Name of PERSON signing Function in organisation Signature It is not possible to sign this form electronically! Co-signature of other participant Organisation full name Name of PERSON signing Function in organisation Signature It is not possible to sign this form electronically! Co-signature of other participant Page 8 of 10
Organisation full name Name of PERSON signing Function in organisation Signature It is not possible to sign this form electronically! Page 9 of 10
ANNEX: PUBLIC AUTHORITIES SUPPORTING THE CLUSTER (Each public authority has to fill in one form) 1 Organisation name Full name Parent organisation 2 Organisation address / switchboard Street Postal code Province (region) Tel Nr. City Country 3 Contact person data Function Direct telephone Email Title 4 Website URL 5 Funding priorities and rules regarding the Cluster's domain Page 10 of 10