PROGRAMS

Application for The Platform

Please do not disclose any proprietary business information. Our policy is to keep your information confidential, but we cannot guarantee its security.

Please answer the questions briefly and to the best of your ability. We understand that you may not yet be able to answer some of the questions in great detail.

Name

Title

Institute or university affiliation

Address

City

State

ZIP

E-mail address

Telephone

Have you discussed this venture with your technology transfer office?

	Yes
	If yes, who in the tech transfer office is managing the case?
	No

Have you formed a company?

	Yes
	It's in the process of being formed.
	No

Briefly describe the backgrounds and current affiliations of the company founders.

Have you raised any funding for the company (i.e., grants, personal investment, private/angel, or venture capital)?

	Yes
	If yes, how much funding have you raised, and where is it from?
	No

Briefly describe your technology

Describe your target customer and the market for your product.

Describe the competitive environment and why your product or technology is special.

If you have a business plan and/or executive summary, please e-mail it to us with your application.

Thank you for your interest in The Platform. We will review your application and respond to you promptly.