Drug Repurposing Venture Challenge Registration Form "*" geeft vereiste velden aan Stap 1 van 4 25% General InformationInformation in this form will be treated confidential unless noted otherwise Please note that a minimum of three and a maximum of four team members can participate in the Venture Challenge program. Name and contact details main participantSalutation Male Female Other Other Salutation*Name*Preferred language of correspondence Dutch English PhoneEmail* Organisation and Faculty*Postal address Name and contact details other membersSalutation Male Female Other Other Salutation*Name*Email*Organisation and Faculty*Add another team member Add another team member Name and contact details other membersSalutation Male Female Other Other Salutation*Name*Email*Organisation and Faculty*Add another team member Add another team member Name and contact details other membersSalutation Male Female Other Other Salutation*Name*Email*Organisation and Faculty* Team Information The team*The team*Availability Please note that a minimum of three and a maximum of four team members can participate in the Drug Repurposing Venture Challenge. The team members need to be available on all the following dates: Coaching trajectory Workshop 1: 2-4 July 2025 Workshop 2: 17-19 September 2025 Pitches for jury: 8 October 2025 Please note: On average each team member needs to be able to free up at least 1 day per week during the 3 months of the Drug Repurposing Venture Challenge to develop the Venture Plan. Availability interview days Interview days: 3 June 2025 and 17 June 2025. Please indicate your availibility for the selection interview. 3 June 2025* 09:00 h 10:00 h 11:00 h 12:00 h 13:00 h 14:00 h 15:00 h 16:00 h Not available for this date 17 June 2025* 09:00 h 10:00 h 11:00 h 12:00 h 13:00 h 14:00 h 15:00 h 16:00 h Not available for this date Number of participants* Please select the number of team members that will participate in the Venture Challenge.Number of participants* Three team members, participation fee €2.000,- Four team members, participation fee €2.500,- Team requirements* A Venture Challenge registration form can be submitted if: The team consists of at least three natural persons, of which a minimum of two member are available for both workshop dates and as described above at ‘’availability’’. The team wants to launch a repurposed drug on the market (see webpage for details). Preferably the inventor or discoverer of the drug repurposing innovation is a member of the team. The team intends to establish a start-up or has recently done so. If the application is submitted by a start-up, then the following additional requirement applies: the start-up is not or has not been active on the market. The start-up or team that registers for the this Drug Repurposing Venture Challenge meets the team requirements stated above:* Yes Registration Information Please note: Information in this section should not exceed 4 pages Venture name* Working name or one line description of the scientific finding you want to commercialize.Venture name*Add imageToegestane bestandstypen: jpg, jpeg, png, gif.Summary* Please provide a brief summary (max 10 lines) suitable for publication, i.e. which contains no sensitive or confidential information.Summary*Add imageToegestane bestandstypen: jpg, jpeg, png, gif.Relation to a University or Knowledge Institute* Does your proposal originate from or is it related to a University or Knowledge Institute? If yes, which University/Institute? Please explain the scientific basis of the drug repurposing innovations under proposition and validation. Indicate the scientific research it is based on. Relation to a University or Knowledge Institute*Add imageToegestane bestandstypen: jpg, jpeg, png, gif.Aim* State the purpose of this start-up. Describe which drug is being repurposed. What is the current indication(s) for which the drug is (has been) registered or formerly investigated for? What is the new indication(s) your are investigating this drug for? Provide a brief description of the improvement and potential impact that your drug repurposing innovation aims to achieve (for patient, healthcare and financially).Aim*Add imageToegestane bestandstypen: jpg, jpeg, png, gif.Proposition and validation* Describe (in brief) the drug repurposing innovation that you have developed or are developing, and the scientific research or idea it is based on. State the extent to which this has been experimentally validated and provide evidence for this in the form of references or data. Proposition and validation*Add imageToegestane bestandstypen: jpg, jpeg, png, gif.Market analysis* Provide a rough estimate of the expected market for your drug repurposing innovation. What is the size of the market (patient population)? What would be the value of your drug repurposing innovation to potential customers (consider all relevant stakeholders) based on expected cost savings or increased productivity (e.g. patients/ caregivers increased participation in labour market)? What share of the market do you think you can ‘’claim’’? How do you expect the market to develop? Market analysis*Add imageToegestane bestandstypen: jpg, jpeg, png, gif.Uniqueness and competition* Who are your ‘’competitors’’ and how does your solution differ from theirs (is it more effective, more safe, cheaper and better to administer for instance)? Does your innovation enable customers (in the broader sense of the word: primarily patients and care givers, but also other relevant stakeholders like health insurance organizations) to do something that was not possible before? Is the timing to introduce your repurposed drug appropriate for patients but also other relevant stakeholders like pharmaceutical companies and investors. Have you protected your solution and if so, how (patents, licenses, exclusive partnerships)? If not protected, why not? Please also describe if other parties have protected parts of your innovation (e.g. are any ongoing patents on your drug). Uniqueness and competition*Add imageToegestane bestandstypen: jpg, jpeg, png, gif.Warning: This is the final step of the form. Please review your input carefully before submitting. NameDit veld is bedoeld voor validatiedoeleinden en moet niet worden gewijzigd. Δ
