Tech Incubation Membership

Page 1 of 2 - Startup Information

50%
Company Name *
Web Site *
Are you incorporated?
Year of Incorporation (If you answered "Yes" above) Year of Incorporation (If you answered "Yes" above) / MM / DD YYYY
Primary Contact Primary Contact * First Last
Email *
Phone Phone * - ### - ### ####
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Links to online profiles *

Links to online profiles like Twitter, LinkedIn, Facebook, Crunchbase, AngelList, Github, or any other online sources for reference.
Upload a pitch deck or any supporting documentations

Select FilesSelect Files

Attach Files
How did you hear about the program? *

How did you hear about the program? Facebook Twitter Newsletter Community Other Other
VENTURE INFORMATION

Please answer the questions accurately as due diligence will be performed upon acceptance.
Elevator Pitch *
Maximum of 100 words allowed. Currently Entered: 0 words.
Briefly describe your venture and communicate it's core value.
Stage of Venture *

Stage of Venture Stage 0 - IDEA (You have an idea and are exploring the market and technology with respect to that idea) Stage 1 - DISCOVERY (You've identified a possible new product or service to introduce to the market at a profit. Your value proposition is established; you are testing ideas and identifying customers; you are looking into financing opportunities) Stage 2 - VALIDATION (You have an established business model; you have a minimum viable product or MVP; you have verified your customers; you have some customer orders) Stage 3 - EFFICIENCY (Customers are being acquired efficiently, product is deliverable at a profit and business model is being fine-tuned; You are pursuing early stage VC.) Stage 4 - SCALE (You have a validated product and market; You're attempting to drive firm growth aggressively; You're seeking A Round financing, making executive hires and refining your process)

Please answer the following questions in regards to the stage of your venture: *
	Yes	No
Do you have a working prototype?	Do you have a working prototype?Yes	Do you have a working prototype?No
Do you have any paying customers?	Do you have any paying customers?Yes	Do you have any paying customers?No
Do you have any non-paying users/customers or any pilot projects underway?	Do you have any non-paying users/customers or any pilot projects underway?Yes	Do you have any non-paying users/customers or any pilot projects underway?No
Do you have any patents filed/granted?	Do you have any patents filed/granted?Yes	Do you have any patents filed/granted?No
Have you received any external funding (including friends & family, angels, VCs, grants, loans, crowdfunding, ICO, etc.)?	Have you received any external funding (including friends & family, angels, VCs, grants, loans, crowdfunding, ICO, etc.)?Yes	Have you received any external funding (including friends & family, angels, VCs, grants, loans, crowdfunding, ICO, etc.)?No
Is your start-up an extension of, or a spin-off from another business/organization?	Is your start-up an extension of, or a spin-off from another business/organization?Yes	Is your start-up an extension of, or a spin-off from another business/organization?No

What is your annual revenue? *
Please identify the areas where you need immediate support: * *

Please identify the areas where you need immediate support: * Defining Overall Business Strategy Product Launch/Go-to market Strategy Implementing/Prototyping Sales and Business Development Marketing and Branding Hiring/Human Resources Connecting with industry/academic/government partners Personal Growth & Development Financial Management Fund raising Other Other
Please identify 2-3 key milestones that you find critical for your venture over the next 3 months *
Maximum of 250 words allowed. Currently Entered: 0 words.
BUSINESS MODEL

Please talk to the various components of your business model and it's scaling opportunities.
What is the problem that your business is trying to solve? *
Maximum of 100 words allowed. Currently Entered: 0 words.
What is your solution to the problem? *
Maximum of 100 words allowed. Currently Entered: 0 words.
What is your main target market? *
Maximum of 100 words allowed. Currently Entered: 0 words.
Explain the demographics and tell us why.
What is your competitive advantage? *
Maximum of 100 words allowed. Currently Entered: 0 words.
What is your revenue model? *
Maximum of 100 words allowed. Currently Entered: 0 words.
What is the runway on your business? *

How long are you able to continue operations without additional funding
PERSONNEL/TEAM INFORMATION

Please provide details of all your team members, including the "Primary Contact" mentioned above.
Number of Founders *

Total number of all equity sharing co-founders, not including employees, contractors, advisors or volunteers
How many non co-founder team members do you have? *

Include any employees, and contractors. Do NOT include co-founders, mentors, volunteers or advisors.
Information of Founder #1
Founder 1 Full Name Founder 1 Full Name * First Last
Email *
Role of Founder *
Maximum of 100 characters allowed. Currently Entered: 0 characters.
Highest Level of Education Completed *

Highest Level of Education Completed High School College University Other Other
Which University or College did you graduate from? *

If this does not apply, please put N/A
Information of Co-Founder #2
Co-founder 2 Full Name Co-founder 2 Full Name * First Last
Email *
Role of Founder *
Maximum of 100 characters allowed. Currently Entered: 0 characters.
Highest Level of Education Completed *

Highest Level of Education Completed High School College University Other Other
Which University or College did you graduate from? *

If this does not apply, please put N/A
Information of Co-Founder #3
Co-founder 3 Full Name Co-founder 3 Full Name * First Last
Email *
Role of Founder *
Maximum of 100 characters allowed. Currently Entered: 0 characters.
Highest Level of Education Completed *

Highest Level of Education Completed High School College University Other Other
Which University or College did you graduate from? *

If this does not apply, please put N/A

Tech Incubation Membership

Page 1 of 2 - Startup Information

VENTURE INFORMATION

BUSINESS MODEL

PERSONNEL/TEAM INFORMATION

Information of Founder #1

Information of Co-Founder #2

Information of Co-Founder #3