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This form should be used for formal application to the Western Health and University of Melbourne Innovation Acceleration Program Proof-of-Concept Fund.
The form should be completed by a joint WH and UoM team in conjunction with a University of Melbourne Business Development staff member (BD) of Research, Innovation and Commercialisation (RIC).
Complete all sections shaded in grey, keeping to the word limit as directed. Documents may be attached to the application (in PDF format) if further detail is required, and should be referred to by title.
The form should not be submitted unless the applicant can truly answer “Yes” or not Applicable (“NA”) to all eligibility criteria in the Eligibility Section.
List any additional UOM or WH project team members (including staff, students and honoraries) to be involved in the project.
We acknowledge and pay respect to the Traditional Owners of the lands upon which our campuses are situated.
Phone: 13 MELB (13 6352) | International: +61 3 9035 5511
The University of Melbourne ABN: 84 002 705 224
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