Lung Cancer Innovation QuickFire Challenge Application Form

china-qfc

Instructions

Remember that solutions will be evaluated by a panel of reviewers and judges on their ability to meet the following criteria:

  1. Potential impact
  2. Uniqueness of solution & level of competition in current market
  3. Quality & feasibility of technology
  4. Team credibility & capabilities
  5. Plans for utilizing JLABS @ Shanghai
  6. Idea submission outlines interest in the innovation ecosystem in Shanghai.

Application Deadline: September 21, 2018.

Steps: Start your application anytime. You can save your incomplete application, click 'Save Form' after you complete the first section.

After saving, you will receive instructions to retrieve your saved application over email. Once you complete your application, click 'Form is completed - Submit'. To go back to the QuickFire Challenge Main page, click here.

Should you have any questions, please email the QuickFire Challenge Team at [email protected] Please refer back to the QuickFire Challenge Website and select your Challenge to view the competition timeline. We will reach with more information after the application deadline (i.e. once all applications have been submitted).

Please fill in your name and email address, in order to save this form.
How did you hear about the Shanghai Lung Cancer Innovation QuickFire Challenge?
Please specify (WeChat):
In which sector(s) does your technology operate?
Please list your team members (if any) and / or collaborators you have engaged and the expertise they bring to the project. Describe any non-confidential prior work that this team has done and experiences to date to deliver a successful project / outcome.
Please give a brief overview of the technology your team is working on. Additionally, please discuss the market you are addressing including market size, how current and emerging trends are converging to create an opportunity for your technology and how your technology will help to reduce costs in this particular market.
Please explain how your idea is a modification or improvement to already existing technologies, products or services or how you believe your idea can change the field completely? (As an example to consider: Are you creating a new, improved TV or are you changing the viewing experience for movies and shows all together?) Please also indicate your competitive advantage relative to the market.
Please explain how you have engaged with key stakeholders regarding your technology and what the feedback has been. Additionally, please describe what type of partnerships you are exploring in order to advance your technology.
Please list your company’s sources of funding to date, funding plans and key milestones you plan to achieve in the next 12 months.
Please provide a short description regarding your work or interest in Shanghai including your plans to work in, engage with the local ecosystem and how the mentorship can critically support your innovation?
Tell us why you or your team should win the Lung Cancer Innovation QuickFire Challenge? Have you built something before? Have you thought of how you would deploy your idea? Have you thought of how you would scale it? Feel free to share any personal stories/hobbies relevant to your idea or business.
These questions are designed to demonstrate J&J’s compliance intentions regarding its Healthcare Compliance Policies and various potentially applicable laws and regulations.

For the purposes of this Questionnaire:
“Government Official or “GO” means any official or employee of a government agency or instrumentality of the government including but is not limited to a political party, party official or candidate, or public international organizations. It also includes individuals representing himself or herself as a GO, for example, a customs official, inspector, auditor, investigator, elected official, or employee of a government ministry or agency. Note that this definition includes agents or employees of some non-governmental (NGO) organizations where those organizations perform quasi-governmental services such as distribution of drugs and medical devices or delivery of health care services, an individual who is an agent or consultant to a government agency, or provides a primary business address at a government facility, uses a military title or rank, supplies an email address associated with a government entity or is otherwise known or believed to be a government employee. Health Ministries and government-owned hospitals often employ HCPs who may be GOs under local law. A private HCP that provides consulting services or otherwise acts as an agent of the government, these individuals should be considered Government Officials. It includes any individual who is a “public official” as defined under the Act on Prohibition of Improper Requests and Provision/Receipt of Money and Valuables of Korea.
“Health Care Professionals” or “HCPs” means:
• All physicians; and
• Any other individual, institution or entity with the ability to prescribe, acquire or influence the prescription or acquisition of the Johnson & Johnson (including its affiliates and subsidiaries) products or services at issue, and either of the following:
 The products at issue are regulated or registered as medicinal products or devices (or their equivalents) in the applicable country; or
 The products or services at issue are subject to reimbursement by government or third parties; or, are offered for sale with products or services subject to such reimbursement.

Examples of HCPs -- depending on the nature of the products or services at issue -- may include, but are not limited to, doctors, nurses, physician assistants, pharmacists, other para-medical staff, members of product formulary committees, health economists, key opinion leaders including scientists and/or PhD’s, clinical investigators and researchers, administrative and management employees of private and public hospitals, HCPs-in-training and medical societies.
“Family Members” means one of the following relationships: mother, father, spouse, civil union partner, sister, brother, son, daughter, grandchild, grandparent, any of the preceding who where applicable, are “step” relatives, mother-in-law, father-in-law, sister-in-law, brother-in-law, son-in-law, and daughter-in-law.

Notes:
1. Please check the boxes for the appropriate answer where the option is provided, or provide the appropriate answer in the space provided.
2. ‘You’ in the questions below refer to the applicant of this QuickFire Challenge.
3. If there is insufficient space in the right column to provide your answers, please add additional pages as necessary.
1a. Are you a government official (GO)?
1b. Are you participating in this QuickFire Challenge as an employee of a government-linked entity or a corporate entity?
SECTION G – For Participants from Government-linked Entities
3a. Are you a HCP (Health Care Professional)?
3b. Please provide the following details.
HCP License
Are you currently practicing as a HCP?
Do you have any influence on the use, recommendation, procurement or approval of J&J products?
4. Are you currently a customer of J&J products or services?
5a. Are any of your family members employees of J&J?
5b. If ‘Yes’, please provide details including name & relationship
SECTION C – For Company Participants
6a. Are there any owners (shareholders or partners) of your company or institution who are HCPs (Health Care Professionals)?
6b. Please provide the names of these HCPs and details of their economic interest and position with your company.
HCP License
Is the HCP Currently Practicing?
%
Does the HCP have any influence on the use, recommendation, procurement or approval of J&J products?
7a. Do any HCPs own options to obtain shares in your company
7b. Please provide the names of these HCPs and details of their economic interest and position with your company.
Is the HCP Currently Practicing?
%
Does the HCP have any influence on the use, recommendation, procurement or approval of J&J products?
8a. Do any HCPs hold debt instruments in your company
8b. Please provide the names of these HCPs and details of their economic interest and position with your company.
HCP License
Is the HCP Currently Practicing?
%
Does the HCP have any influence on the use, recommendation, procurement or approval of J&J products?
9a. Are any key personnel (Board members, Officers of the company, key employees) a HCP?
9b. Please provide the names of these HCPs and details of their economic interest and position with your company.
HCP License
Is the HCP Currently Practicing?
Does the HCP have any influence on the use, recommendation, procurement or approval of J&J products?
10a. Are your company owners, partners, shareholders, or key decision makers a Government Official or affiliated with a Government Official?
10b. If ‘Yes’, please provide name(s) and the individual’s(s’) position(s).
11a. Are your company owners, partners, shareholders, key decision makers currently working for a government-owned or a government-linked institution (e.g., a public hospital) which is or could potentially be a J&J customer? Note: This includes providing advisory, consulting or part-time services.
12a. Are any of the family members of the owners, principals, or board members of your company or your parent company employees of J&J?
12b. If ‘Yes’, please provide details, including name and relationship
Completed by
Sign above
One file only.
100 MB limit.
Allowed types: odf pdf doc docx ppt pptx gz rar tar zip.
One file only.
100 MB limit.
Allowed types: odf pdf doc docx ppt pptx gz rar tar zip.

JLABS QUICKFIRE CHALLENGE (“QFC”) APPLICATION TERMS 
By submitting requested information (“Application”) as part of this QFC, you on behalf of yourself and/or your company (“Applicant”) agree to abide by these Application Terms (the “Terms”), the terms and conditions of our vendor, FluidReview (https://fluidreview.com/about/legal), and the decisions of Johnson & Johnson Innovation LLC (“JJI”), JJI’s parent company, affiliates or partner on this QFC, which shall be final and binding in all respects. 
By submitting an Application, Applicants warrant that no information provided as part of the Application IS OR can be deemed confidential OR proprietary, considered a trade secret or privileged.
Applicant acknowledges and agrees that a confidential relationship is not established or implied by JJI’s acceptance or consideration of an Application.  All submissions are voluntary and submitted on a non-confidential basis only.  Applicant acknowledges and agrees JJI shall have the right to consider all information disclosed in the Application as non-confidential and have the right to disclose all such information to its internal employees and consultants and to any third party, at any time and for any purpose.
The QFC will be announced via email, press release and/or a social media post (collectively, the “QFC Announcements”).  A QFC Announcement will include how to apply, the application deadline and the award for that QFC.  All information contained in a QFC Announcement is incorporated herein by reference. To the extent that there is a conflict between a QFC provision of the QFC Announcement and these Terms, these Terms shall prevail with respect to such provision.
WHO CAN PARTICIPATE: Applications should only be submitted by authorized representatives of Applicant applying for the QFC. To qualify, each Applicant must submit an innovative idea addressing lung health in at least one of the following categories

  1. Medical Devices
  2. Pharmaceuticals
  3. Health Technologies
  4. Consumer Products
  5. Global Public Health
Applicants are responsible for complying with any company policies related to participating in programs of this nature, including, but not limited to, obtaining any necessary consents from their company to participate and to provide the information required for the Application and to submit it.
WHO CANNOT PARTICIPATE: While all potential applicants are encouraged to apply, those that are Health Care Providers (“HCPs”), Government Officials (“GOs”) or any organization affiliated with either will be subjected to additional review and may not be ultimately eligible to participate. Definitions of HCPs and GOs can be found below. In addition, even if an Applicant is ultimately not eligible to participate, we encourage potential Applicants to still apply as they may be considered by JJI for future opportunities, separate and apart from the QFC.


HOW TO SUBMIT AN APPLICATION:  Visit www.jnjawards.fluidreview.com and follow the directions provided to complete and submit the Application.  You represent that all information provided as part of the Application is truthful and accurate.  Limit one (1) Application per Applicant per QFC.  All Applications become the property of JJI.  All Applications must be received by the deadline stated.
By submitting an Application, Applicants represent and warrant that:        
  1. all information contained in the Application is original to the Applicant or the Applicant has secured all rights to submit the Application;        
  2. no information is or can be deemed confidential or proprietary, considered a trade secret or privileged;        
  3. neither the Applicant’s Application nor JJI’s use of the Application (or information contained thereon), in whole or in part, violates the right(s) of any third party;         
  4. all activities of an Applicant’s business initiative are lawful;         
  5. the Application does not contain offensive or libelous material, is truthful and not misleading;         
  6. the Applicant has considered and complied with all contractual and/or confidentiality commitments that may be applicable to his/her Application, including compliance with business privacy policies, data use policies, policies governing disclosure of company information, agreements with third parties, and any other company policies or commitments that may be applicable; and       
  7. Applicant has submitted the Application in accordance with these Terms. 
Applicant understands and agrees to be responsible for applying for any necessary intellectual property protections in connection with any information provided as part of the Application, including, but not limited to, any patents, prior to submitting the Application.  Applicant acknowledges and agrees that JJI is not responsible and will have no liability for any claims or actions associated with Applicant’s failure to do so. 
Each Applicant understands and acknowledges, to the extent permitted by law, that: i) JJI has wide access to ideas, designs, protocols, methodologies and other materials (collectively, “Ideas”), and those new Ideas are constantly being submitted to it or being developed by their own employees; ii) many Ideas may be competitive with, similar to, or identical to content in the Application and/or each other in concept, approach, format, or other respects; iii) Applicant  will not be entitled to any compensation as a result of JJI's development or use of any such similar or identical material that has or may come to JJI, or any of them, from other sources. Except where prohibited by law, each Applicant acknowledges and agrees that JJI does not now and shall not have in the future any duty or liability, direct or indirect, vicarious, contributory, or otherwise, with respect to the infringement or protection of the entrant’s copyright, patent or other intellectual property right in and to the submission. Finally, to the extent permitted by law, each Applicant acknowledges that, with respect to any claim by Applicant relating to or arising out of any JJI's actual or alleged exploitation or use of any Application or other material submitted in connection with the QFC, the damage, if any, thereby caused to the applicable Applicant will not be irreparable or otherwise sufficient to entitle such Applicant to seek any injunctive or other equitable relief or in any way enjoin, otherwise interfere with, delay, or interrupt the production, distribution, exhibition, or other exploitation of any production based on, or allegedly based on, the Application, and, to extent permitted by applicable law, Applicant’s rights and remedies in any such event shall be strictly limited to the right to recover reasonable and documented out-of-pocket costs associated with entering the QFC, if any, in an action at law.
ACCOUNT, PASSWORD AND SECURITY: As part of the registration process required to submit an Application, you will create a password and account. You are responsible for maintaining the confidentiality of the password and account, and are fully responsible for all activities that occur under your account. You agree to (a) immediately notify JJI of any unauthorized use of your password or account or any other breach of security, and (b) ensure that you exit from your account at the end of each session. JJI cannot and will not be liable for any loss, damage or other liability arising from your failure to comply with this section or from any unauthorized access to or use of your account. In the event of any dispute between two or more parties as to account ownership, you agree that JJI shall be the sole arbiter of such dispute in its sole discretion and that JJI's decision (which may include termination or suspension of any account subject to dispute) shall be final and binding on all parties.
PRIVACY: JJI is committed to protecting the privacy of Applicants. Please see JJI’s Privacy Policy and FluidReview’s Privacy Statement for more information.
APPLICANT SCREENING AND SELECTION: Initial Application Review: Applications submitted for the QFC may be transmitted to/from the United States and will be reviewed by representatives of JJI, JJI’s parent company, affiliates or partners. Eligible Applications received during the QFC Period will be reviewed for eligibility and eligible Applications will be judged based on the following criteria, weighed equally: project for which the Applicant proposes to use the award, strategic fit, and Applicant’s proposal for how the award will be utilized for the Applicant’s project.  Presentations: A select number of Applicants will be invited to present their proposals addressing at least one of the categories above before representatives of JJI (“Selected Applicants”), JJI’s parent company, affiliates or partners. All details of the presentations will be provided to Selected Applicants at time of notification, including, without limitation, date and time of presentation and any guidelines with respect to what must be presented and how.
No part of the presentation should contain information that is or could be deemed confidential or proprietary, considered a trade secret or privileged. The “Award Recipients” will be determined by JJI, JJI’s parent company, affiliates or partners from among the Selected Applicants. JJI reserves the right to not provide all awards if it does not receive a sufficient number of eligible and qualified Applications.  Decisions of JJI are final and binding in all matters. Award Recipients will be announced on the date specified in the QFC Announcement. Potential Award Recipients will be required to execute and return an Applicant Agreement and Release and other documentation within a time period specified by JJI. If such documents are not returned within the specified time period, a potential Award Recipient cannot be contacted within a reasonable time period or is not in compliance with these Terms, such potential Award Recipient will be disqualified and another Applicant may, in JJI’s sole discretion, be selected and the award awarded to another eligible Applicant in accordance with these Terms.  
AWARD: The award will be set forth in the QFC Announcement.  The exact value of the award will be provided to Selected Applicants at time of notification. The award may not be substituted, assigned or transferred or redeemed for cash, however JJI reserves the right, at its sole discretion, to substitute an award (or portion thereof) with one of comparable or greater value.  Recipients are responsible for all applicable federal, state, provincial and local taxes, if any, as well as any other costs and expenses associated with award acceptance and use not specified herein or in the QFC Announcement as being provided.
PUBLICITY GRANT:  By accepting an award, each Award Recipient agrees to the use by JJI and its designees of Applicant’s name, company name, trademarks and logos, city and province/state of residence, images and/or likenesses for advertising and publicity purposes, in any manner, in any and all media, now or hereafter known, worldwide in perpetuity, without compensation (unless prohibited by law) or additional consents and without prior notice, approval or inspection, and to execute specific consent to such use if asked to do so.
RELEASE OF LIABILITY:  By submitting an Application, to the extent permitted by law, Applicants agree to release, discharge, hold harmless and indemnify JJI, its parent, affiliates, subsidiaries, and advertising and promotion agencies, FluidReview, partners of the QFC, and the respective officers, directors, shareholders, employees, agents and representatives of the foregoing (collectively, “Released Parties”) from any and all injuries, liability, losses and damages of any kind (including, without limitation, arising from claims based upon invasion of privacy, defamation, or right of publicity) to persons, including death, or property resulting, in whole or in part, directly or indirectly, from Applicant’s participation in the QFC and/or the use of the award or any Released Party’s use of any information provided as part of the Application.  
TAXES:  Recipients are responsible for all applicable federal, state, provincial and local taxes, if any, as well as any other costs and expenses associated with Award acceptance and use not specified herein or in the QFC Announcement as being provided.

GENERAL CONDITIONS: To the extent permitted by law, Released Parties are not responsible for lost, late, incomplete, damaged, inaccurate, stolen, delayed, misdirected, undelivered or garbled Applications; or for lost, interrupted or unavailable network, server, Internet Service Provider (ISP), website, or other connections, availability or accessibility or miscommunications or failed computer, satellite, telephone or cable transmissions, lines, or technical failure or jumbled, scrambled, delayed, or misdirected transmissions or computer hardware or software malfunctions, failures or difficulties, or other errors or difficulties of any kind whether human, mechanical, electronic, computer, network, typographical, printing or otherwise relating to or in connection with the QFC or the Application process, including, without limitation, errors or difficulties which may occur in connection with the administration of the Application process or in any Application and QFC-related materials.  Released Parties are also not responsible for any incorrect or inaccurate information, whether caused by site users, tampering, hacking, or by any equipment or programming associated with or utilized in the Application process or the QFC.  Released Parties are not responsible for injury or damage to any person's computer related to or resulting from participating in this Application process or downloading materials from or use of the website.  Persons who tamper with or abuse any aspect of the Application process or website, who act in an unsportsmanlike or disruptive manner or who are in violation of these Terms, as solely determined by JJI, will be disqualified. JJI reserves the right at its sole discretion to suspend, modify or terminate the Application process at any time and for any reason.  CAUTION: ANY ATTEMPT TO DELIBERATELY DAMAGE THE WEBSITE OR UNDERMINE THE LEGITIMATE OPERATION OF THE APPLICATION PROCESS MAY BE IN VIOLATION OF CRIMINAL AND CIVIL LAWS AND SHOULD SUCH AN ATTEMPT BE MADE, JJI RESERVES THE RIGHT TO SEEK DAMAGES AND OTHER REMEDIES (INCLUDING ATTORNEYS’ FEES) FROM ANY SUCH INDIVIDUAL TO THE FULLEST EXTENT OF THE LAW, INCLUDING CRIMINAL PROSECUTION. Void where prohibited by law. QFC is subject to all applicable federal, provincial, state and local laws.


CHOICE OF LAW: To the extent permitted by law, Applicant understands that any and all legal actions or claims arising in connection with this QFC must be brought in a court of competent jurisdiction in the State of New York. Applicant agrees, to the extent permitted by law, that: (1) any and all disputes, claims and causes of action arising out of or connected with the QFC or any award provided shall be resolved individually, without resort to any form of class action, (2) any and all claims, judgments and awards shall be limited to actual out-of-pocket costs incurred, and in no event will I be entitled to obtain attorneys' fees or other legal costs; and (3) no punitive, incidental, special, consequential or other damages, including without limitation lost profits may be awarded (collectively, "Special Damages"), and (4) Applicant hereby waives all rights to claim Special Damages and all rights to have such damages multiplied or increased.  New York law, without reference to New York choice of law rules, governs the QFC and all aspects related thereto.
[“Government Official or GO” means any official or employee of a government agency or instrumentality of the government including but is not limited to a political party, party official or candidate, or public international organizations. It also includes individuals representing himself or herself as a GO, for example, a customs official, inspector, auditor, investigator, elected official, or employee of a government ministry or agency.  Note that this definition includes agents or employees of some non-governmental (NGO) organizations where those organizations perform quasi-governmental services such as distribution of drugs and medical devices or delivery of health care services, an individual who is an agent or consultant to a government agency, or provides a primary business address at a government facility, uses a military title  or rank, supplies an email address associated with a government entity or is otherwise known or believed to be a government employee. Health Ministries and government-owned hospitals often employ HCPs who may be GOs under local law. A private HCP that provides consulting services or otherwise acts as an agent of the government, these individuals should be considered Government Officials.
“Health Care Provider” or “HCP” means: 
  • All physicians; and   
  • Any other individual, institution or entity with the ability to prescribe, acquire or influence the prescription or acquisition of the Johnson & Johnson (including its affiliates and subsidiaries) products or services at issue, and either of the following:  
    • The products at issue are regulated or registered as medicinal products or devices (or their equivalents) in the applicable country; or
    • The products or services at issue are subject to reimbursement by government or third parties; or, are offered for sale with products or services subject to such reimbursement.

Examples of HCPs -- depending on the nature of the products or services at issue -- may include, but are not limited to, doctors, nurses, physician assistants, pharmacists, other para-medical staff, members of product formulary committees, health economists, key opinion leaders including scientists and/or PhD’s, clinical investigators and researchers, administrative and management employees of private and public hospitals, HCPs-in-training and medical societies.]JLABS QUICKFIRE CHALLENGE (“QFC”) APPLICATION TERMS 
By submitting requested information (“Application”) as part of this QFC, you on behalf of yourself and/or your company (“Applicant”) agree to abide by these Application Terms (the “Terms”), the terms and conditions of our vendor, FluidReview (https://fluidreview.com/about/legal), and the decisions of Johnson & Johnson Innovation LLC (“JJI”), JJI’s parent company, affiliates or partner on this QFC, which shall be final and binding in all respects. 
By submitting an Application, Applicants warrant that no information provided as part of the Application IS OR can be deemed confidential OR proprietary, considered a trade secret or privileged.
Applicant acknowledges and agrees that a confidential relationship is not established or implied by JJI’s acceptance or consideration of an Application.  All submissions are voluntary and submitted on a non-confidential basis only.  Applicant acknowledges and agrees JJI shall have the right to consider all information disclosed in the Application as non-confidential and have the right to disclose all such information to its internal employees and consultants and to any third party, at any time and for any purpose.
The QFC will be announced via email, press release and/or a social media post (collectively, the “QFC Announcements”).  A QFC Announcement will include how to apply, the application deadline and the award for that QFC.  All information contained in a QFC Announcement is incorporated herein by reference. To the extent that there is a conflict between a QFC provision of the QFC Announcement and these Terms, these Terms shall prevail with respect to such provision.
WHO CAN PARTICIPATE: Applications should only be submitted by authorized representatives of Applicant applying for the QFC. To qualify, each Applicant must submit an innovative idea addressing lung health in at least one of the following categories