worTechConnect World & National Innovation Summit

Innovation Submission

Contact Information
First name:
Last name:
Organization:
Job title:
Address:
City:
State:
ZIP:
Country:
Phone:
Cell phone:
Fax:
E-mail:
Note: Your contact and innovation/company information will be made available to corporate/investment partners and conference attendees if your organization is invited to participate in the summit.
Organization Information
Company or Organization:
Website URL:
Organization size: / [ ] 1 — 19
[ ] 20 — 99
[ ] 100 — 499
[ ] 500 — 2499
[ ] 2500 or more
Innovation/Company Details
List as you want printed in the program.
Title/Name of Technology:
Technology Summary:
Enter a brief description of your technology/innovation in layman’s terms (50 words max)
Executive Summary:
Enter an executive summary including a very brief business model and market description. How is your Innovation addressing a need/problem in the marketplace? (200 words max.)
Technology Development Status: / [ ] Concept
[ ] Prototype
[ ] Proven Manufacturability
[ ] Ready to Market
[ ] Commercial Product
Select your Technology Readiness Number (TRL) / [ ] TRL 1
[ ] TRL 2
[ ] TRL 3
[ ] TRL 4
[ ] TRL 5
[ ] TRL 6
[ ] TRL 7
[ ] TRL 8
[ ] TRL 9
TRL numbers are defined here: esto.nasa.gov/files/TRL_definitions.pdf
Organization Type: / [ ] Academic/Gov Lab
[ ] Early-stage Startup (Seed)
[ ] Mid-stage Startup (A or B)
[ ] Commercial Startup (C+)
[ ] Corporation
Primary Application Area: / [ ] Materials & Chemical
[ ] Biotech & Biological Sciences
[ ] Medical Devices
[ ] Pharmaceuticals & Personal Care
[ ] Foods & Agriculture
[ ] Electronics, Sensors & Communications
[ ] Instrumentation & Manufacturing
[ ] Aerospace & Defense
[ ] Automotive & Transportation
[ ] Conventional Energy
[ ] Renewable & Hydrogen Energy
[ ] Energy Storage
[ ] Energy Management & Distribution
[ ] Environmental, Water & Waste
[ ] IT, Cyber-Security, Software
[ ] Other
Other:
(if you selected Other in the pull-down above)
Specific Market Keywords:
Enter up to 3 market descriptors separated by commas. Please help us find your best fit corporate or investment partner by narrowing down your specific market focus. Please take care in this essential selection and partnership step.
Technology Keywords:
Enter up to 3 technology keywords separated by commas. Again, this step is essential in our partnering process. We request that you provide a very concise set of key words summarizing “what technology approach” do you use in addressing your key market.
Government Program Funding/Support to-date / Please select the Government Program(s) that support your Innovation/Company (select all that apply):
[ ] DOD SBIR/STTR
[ ] DOE SBIR/STTR
[ ] NIH SBIR/STTR
[ ] SBIR/STTR Other
[ ] State Grant/Loan
[ ] Federal (non-SBIR/STTR) Grant/Loan
[ ] N/A (no funding/support received)
Please provide any additional details on Government programs checked above (Phase I-II-III, Agency/Sub-Agency/Component/Office, Award Amount, Year/Duration) (200 words max.)
Non-government Funding/Support:
List any disclosable financing to-date, i.e., Angel, Venture, Corporate, etc. (50 words max.)
Awards and Vetted Programs
List any involvement in vetted programs or awards, i.e., TechConnect National Innovation Award, R&D 100 Award, Rice Alliance Venture Finalist, CTSI Defense Energy Challenge, etc. (200 words max.)
License or Partner Agreements
List any disclosable licensing or corporate/government partnerships tied to your Innovation/Company (200 words max)
Market Size & Strategy:
Define what your addressable market, market size and your market strategy? (200 words max.)
Management or Innovation Team:
Please document 3 key business or innovation team members? (100 words per individual, 300 words max.)
Who/What is your Competition?:
(50 words max.)
What is your Value Proposition?:
What makes this IP attractive to the market? How is this an improvement over an existing technology or company? Answer the question “So What?” (50 words max.)
Are you looking for:
(Check one) / [ ] Funding
[ ] Development / License Partners
[ ] Both Funding and Development Partners
Whatareyourprimary
sourcesoffunding?*: / [ ] Angel, Friends, Family
[ ] Venture Capital
[ ] Corporate Venture Capital
[ ] Corporate Partner / [ ] Personal Savings
[ ] Federal Grant
[ ] University
[ ] Other
Consider my Technology for the TechConnect Defense Innovation Summit?
Austin Texas, December 1-3, 2015 / [ ] Yes
[ ] No