The GCC Application Form - Keralink International

The Great Cornea Challenge Application Form

Applicant Details

Full Name:

Organization/Institution (if applicable):

Contact Email:

Contact Phone Number:

Country of Residence:

The Problem You Are Solving (Describe the pain that you are alleviating, preferably in personal terms)

Your Solution (Explain how you alleviate the pain - what do you sell and what is your value proposition?)

Your Business Model (How do you make money? Who pays you? What are your distribution channels? What are your gross margins?)

Your Underlying Magic (Describe the technology or “secret sauce" or "magic", etc. behind the product or service. How is your IP protected?)

Marketing (What are the products and services that you will be producing? Describe the marketing strategies for your products and services.)

Sales (Describe how you plan to reach your customers and identify your key leverage points.)

Management Team (Key players – management, board of directors, board of advisors, and investors, if any)

Projections and Key Metrics (Five year forecast - include dollars and metrics like number of customers and conversion rate).

Current status, accomplishments, timeline and use of funds (Where are you right now, what does the near term future look like and what you will do with the money you're trying to raise? Assign milestone completion dates wherever possible)

Technology, Product and/or Service Details:

Name:

Brief Description: (Provide a concise description of your idea, technology, product and/or service in 200 words or less.)

How does this idea, technology, product and/or service specifically address corneal diseases? (Describe current standard of care and clinical problem you are solving. Max 300 words)

Who are your main competitors? (Max 300 words providing a complete view of the competitive landscape)

Stage of Development:

Idea/Concept Prototype Clinical Trials Market Ready

What is your Intellectual Property (IP) Status? (select multiple if applicable)

Further comments (short answer, max 200 words)

Relevance to Low and Middle Income Countries (LMICs):

Adaptability: How is your idea, technology, product and/or service adapted or adaptable to the specific needs and constraints of LMICs? (Max 250 words)

Cost-Effectiveness: Provide an estimate of the cost of implementing your idea, technology, product and/or service in LMICs and justify its cost-effectiveness. (Max 250 words)

Training & Maintenance: Describe any training or maintenance required for your idea, technology, product and/or service and how it can be feasibly implemented in LMICs. (Max 250 words)

Risk and Success Potential:

Risk Assessment: Describe the potential risks associated with your idea, technology, product and/or service and how they can be mitigated. (Max 300 words)

Success Potential: Describe why you believe your idea, technology, product and/or service has a high likelihood of success despite the associated risks. (Max 300 words)

Additional Information:

Supporting Documents: Attach any relevant business plans, financial projections, research papers, patents, or other supporting documents that can provide more insight into your technology. (only jpg, gif and pdf files are allowed to upload)

References: List any individuals or organizations that can vouch for the viability, potential and/or commercial use of your idea, technology, product and/or service. Feel free to attach up to two letters of recommendation in the supporting documents portion. (only jpg, gif and pdf files are allowed to upload)

Weighting Criteria:

Overall Idea, Technology, Product and/or Service Description & Stage of Development: 40%
Description and application to corneal disease: 15%
Competitors: 10%
Stage of Development and IP: 15%
Relevance to LMICs: 30%
Adaptability: 10%
Cost-Effectiveness: 10%
Training & Maintenance: 10%
Risk and Success Potential: 30%
Risk Assessment: 20%
Success Potential: 10%

Weighting Criteria:

Overall Idea, Technology, Product and/or Service Description and Stage of Development (Total weighting, 40%)

Description and application to corneal disease: 15%
Competitors: 10%
Stage of Development and IP: 15%

Relevance to LMICs (Total weighting, 30%)

Adaptability: 10%
Cost-Effectiveness: 10%
Training & Maintenance: 10%

Risk and Success Potential (Total weighting 30%)

Risk Assessment: 20%
Success Potential: 10%

Declaration:

I hereby declare that all the information provided in this application is true and accurate to the best of my knowledge.

The Great Cornea Challenge Application Form

Applicant Details

Technology, Product and/or Service Details:

Relevance to Low and Middle Income Countries (LMICs):

Risk and Success Potential:

Additional Information:

Weighting Criteria:

Weighting Criteria:

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