项目入驻-北京大学上海临港北京大学国际科技创新中心

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Project Application Form

Filling Instructions

1．This application form is to be used for applying to join the Peking University Shanghai Lin-gang International Science and Technology Innovation Center (PKU-IICSH). Please read the filling instructions carefully before completing the form. All information must be truthful and accurate.

2．The "Project Name" should be concise and clear.

3．For "Unit," please fill in the secondary unit where the project leader's human relations are maintained.

4．If there is not enough space in any section, additional pages may be attached.

5．Printed materials should be double-sided on A4 paper, stamped, and submitted in two copies.

Basic Information

Project Name:

Industries：

Project Leader

Full name：

Gender：

Date of Birth (DD/MM/YY)：

Unit：

Title：

Academic Degree：

In (year), received the highest degree of

Major：

E-mail：

Tel：

Phone Number：

The research and industrialization team consists ofindividuals, within the research team andin the industrialization team. There areindividuals holding senior professional titles,with doctoral degrees, andwith master’s degree.

Funding Application (In 10,000 RMB)

Annual	Amount (In 10,000 RMB)	Usage	Self-raised Fund (In 10,000 RMB)
2024
2025
2026
2027
Total Amount：

Received Support

Vertical Funding (research funding for government fiscal allocation projects)：

Local Government Support：

Horizontal Funding (revenue obtained through undertaking corporate and social sci-tech projects, conducting research collaborations, transferring sci-tech achievements, and providing scientific and technological consulting services, as well as other research-related income)：

Other Funding：

Project Overview (3-4 Year Plan)

Output Dependency：

Core Product：

Market Analysis：

Implementation Plan：

Project Leader’s Profile

Space Requirements

Expected Goals and Outcomes

Business Plan (if available, please attach; attachments size should not exceed 10MB)

Financing Plan (if available, please attach; attachments size should not exceed 10MB)

Other Requirements (if available, please attach; attachments size should not exceed 10MB)

I hereby promise that I will accept the funding from Peking University Shanghai Lin-gang International Science and Technology Innovation Center (PKU-IICSH) for the project. I will be responsible for implementing this project according to the application, approval opinions, and project agreement. I will strictly adhere to the regulations regarding project management, finances, and other related matters, ensuring the allocated time for research and development, conducting R&D diligently, submitting relevant materials on time, promptly reporting any significant changes, and complying with the agreement requirements for publishing papers and obtaining financing for the sponsored projects.

I confirmed the above commitments Yes No

Project Leader (Signature)

Date

附件：可量化指标参考附表