350 Research Grants - Application Form

Please complete all sections and send the completed form to

350researchgrants@merckgroup.com

This application refers to the following Challenge:

☐The next game changing molecule or technology to help fight cancer or autoimmune disease
☐The next generation production technology for biologics
☐Revolutionizing microbiome research
☐The next generation of intelligent material
☐Characterization, control and surface chemistry
☐Atomic layer processes – from modelling to materials
☐How can in-silico research benefit from deep learning or quantum computing

Personal Data of the applicant

Surname Click or tap here Address Building & Street
Click or tap here
to enter text. (office address to enter text.
representing the
ZIP Click or tap here
entity, which shall
receive the funding to enter text.
First Name Click or tap here City
(e.g. the institute,) Click or tap here
to enter text. to enter text.
Country Click or tap here
to enter text.
Name of Institute / Click or tap here Add address if Building & Street Click or tap here
Entity / Company / to enter text. different from to enter text.
Start-up the above ZIP Click or tap here
proponent is
to enter text.
affiliated to
City Click or tap here
to enter text.
Country Click or tap here
to enter text.
Name and Place of Click or tap here Add address if Building & Street Click or tap here
research (where the to enter text. different from to enter text.
research described above ZIP Click or tap here
below will be -
performed) to enter text.
City Click or tap here
to enter text.
Country Click or tap here
to enter text.
☐I am submitting this application as the spokesperson for a collaborative team (list your other
team members below)

Surname First Name Name of Institute / Entity / Company / Email

Start-up the proponent is affiliated to

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 350 Research Grants - Application Form
Please complete all sections and send the completed form to
350researchgrants@merckgroup.com
Research Proposal
Title Click or tap here to enter text.

Short abstract
(limit 100 words) Click or tap here to enter text.

Research Proposal
PROVIDE ONLY NON-CONFIDENTIAL INFORMATION
Objective of the research
(e.g. what is the scientific question and rational;
limit 150 words)
Click or tap here to enter text.

Impact of the objective / expected results

(e.g. why is this research important; references can be used if relevant; limit 400 words)
Click or tap here to enter text.
Description of the research (which experiments are planned to address the objective of the project, rationale why
these experiments are planned and not other options (if there are any;
limit 1000 words, you may want to add figures, graphs etc.)
Click or tap here to enter text.
References for the research
Click or tap here to enter text.
Other relevant information
Click or tap here to enter text.

Terms and conditions

☐Yes
Confirmation on the I, the applicant, herewith confirm that the
correctness of the information stated on this form is correct and to the
best of my knowledge. ☐No
information

I, the applicant, herewith confirm that I am entitled ☐Yes

to request and obtain the 350 Research Grant
Entitlement to request the funding without violating any requirements of my ☐No
Grant employer / institute or any other existing obligation
and to have obtained all necessary employer ☐N/A
approvals.
☐Yes
Confirmation to be I, the applicant, herewith confirm that I am entitled
entitled to request the to request and obtain the 350 Research Grant
☐No
Grant on behalf of funding on behalf and for my employer / institute
institution (as identified and to have obtained all necessary employer
approvals. ☐N/A
above)

I, the applicant, herewith confirm to have read and ☐Yes

Agreement on the terms understood the terms and condition of attached to
and conditions this application form and I agree to be bound by its ☐No
Terms and Conditions.

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 350 Research Grants - Application Form
Please complete all sections and send the completed form to
350researchgrants@merckgroup.com
Data Privacy Information

Merck KGaA, Frankfurter Str. 250, 64293 Darmstadt, Germany, uses your personal data collected in this form for
evaluating your application, including to contact you via phone or e-mail (Art. 6 (1) b) General Data Protection
Regulation), to track repeat and multiple applications from the same applicant, and to use this information to
prepare a 350 Anniversary Research Grant Agreement (contract) between a research institution you are affiliated
with, and Merck in the event that your research proposal is selected for the 350 Anniversary Research Grant. We
process the information you provide, in accordance with our Privacy and Cookie Policy. By providing the above
information, you consent to such processing and you warrant that all information you provide about yourself is
true, accurate, current and complete. Furthermore, you confirm that you obtained the explicit consent of any
other persons whose personal data you may provide. You understand that transmission of information via the
internet is not completely secure and is not encrypted; Internet or phone service providers are third parties used
for delivery of the messages therefore you understand that transfer of messages via these communications
channels are subject to their own terms and conditions.

Your personal data will only be shared by us with Merck affiliates and partners, including, but not limited to an
independent review committee evaluating your application for the purposes of such evaluation. Where we share
your data with recipients outside of the EU, we conclude standard contractual clauses ("Clauses") issued by the
EU Commission to safeguard your data.

You have a right to receive and inspect your stored personal data, to demand its correction or deletion, to object
to its future use and to receive copies of the Clauses, for example by contacting our data protection officer
(privacy@merckgroup.com). We will keep your data as long as we may collaborate with you (now or in the
future).

Signatures:

Name of Applicant in printed letters: Click or tap here to enter text.

Date: Click or tap here to enter text.

Signature: ______________________________

(If applicable)

We have read the Terms and Conditions and herby consent to such:

Name of Institution: Click or tap here to enter text.

Date: Click or tap here to enter text.

Title and name of Institute representative: Click or tap here to enter text.

Signature: ______________________________

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