Application Form

Dick Plettenburg Fund – Application Form

The Dick Plettenburg Fund supports and accelerates the transition from research to the patient, particularly through a EUR 25k grant for (pre-)start-ups.

Applicant
Name*
Email*
Phone*
Address and house number*
Faculty*
Research Group From Which Startup Originated (if not the case, fill out: Not applicable)*
Name of company*
Bank account if granted (IBAN)*
Fit to Dick Plettenburg Fund
Please explain if and how you meet the following criteria:
1. Link to TU Delft (team and product idea)*
2. Project is treating / supporting individuals with physical or cognitive disabilities, with focus on rehabilitation*
3. High chance valorisation of project is possible (certain maturity stage)*
4. No subsidies, investments, income > EUR 50k raised*
5. Grant will not be spent on FTEs*
6. Project involves hardware development*
Motivation and Experience
Max 200 words
Motivation and Experience*
Team*
Summary of your Idea
Max 500 words
Product*
Novelty (incl. patents)*
Technical Feasibility & Scalability*
Market & Opportunity
Market size and trends*
Competition*
Traction*
Business opportunity & Motivation*
Project plan & Financials
Project activities over time incl. milestones*
Budget spend EUR25.000 including timings (in 2 tranches)*
NB: not no be spent on team, but e.g., on product development and market assessment
Plan for additional funding*
Why should we invest in your idea? (1 sentence)*
Business plan and/or pitch deck*
Max. file size: 64 MB.
Undersigned has read and agrees with the general conditions*
Yes
• Undersigned has completed this application truthfully
• Within 2 months after spending the EUR25.000, a summary of activities, financials and
results will be shared with the Dick Plettenburg Fund
• Undersigned is aware of the ‘Giving Back Pledge’ should an exit take place
• Undersigned will share his/her expertise with new applicants should the Dick Plettenburg
Fund ask him/her to do so
• Undersigned will share a short business update on a yearly basis once a start-up is
installed
• Undersigned will mention TU Delft and Dick Plettenburg Fund in all relevant
communication
• Undersigned has attached a business plan and or pitch deck to this form

Dick Plettenburg Fund – Application Form

Applicant

Fit to Dick Plettenburg Fund

Motivation and Experience

Summary of your Idea

Market & Opportunity

Project plan & Financials