LifeSci Stars Action application form

Your name*

Email address*

Date of birth*

Academic Institution*

Job title*

If you are applying as part of a team, please provide the full names of all additional team members (note - only one application per team is required)

Team name (if applicable)

Experience*:
Briefly describe your attributes, skills and any relevant experience you may have. Please also fill in for any additional team members.

What domain is your research/idea/startup in*?
—Please choose an option—Digital HealthTherapeuticsDiagnosticsMedtechAIPlatform

Idea description*:
Please give a brief description of your research area or idea (Max 100 Words)

What is the unmet need/problem you are trying to address*?
Identify the scientific and/or market need that you are proposing a solution for. (Max 200 words)

What is the potential impact of your research/idea?*:
A brief description on the potential impact of your idea on patients, healthcare providers and society. (Max 100 Words)

What is unique about your research/idea?*:
What makes your idea different? What makes you different from what is already out there? What is your USP? (Max 100 Words)

Intellectual Property*:
Has any action been taken to protect IP? If so, please provide further details, including licensing agreements with academic institutions. (Max 100 words)

I agree to the Panacea Stars Terms & Conditions