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Entrepreneurial Lead Name *

Entrepreneurial Lead Phone Number *

Entrepreneurial Lead Email Address *

Entrepreneurial Lead LinkedIn Profile *

Insert URL here - should start with "www.linkedin.com/in/"

Technical Lead Name

Technical Lead Phone Number

Technical Lead Email Address

Technical Lead LinkedIn Profile

Insert URL here - should start with "www.linkedin.com/in/"

Mentor Name

Mentor Phone Number

Mentor Email Address

Mentor LinkedIn Profile

Insert URL here - should start with "www.linkedin.com/in/"

Please list any additional team members, their roles and contact information

Other team member name, email and phone number

Company Name, if one exists *

If incorporated, is this entity at least 51% owned by U.S. citizens or other small U.S. businesses? *

Yes

No

Not Applicable

Describe your technology research (200 words) *

Plain text please

Describe how you think this technology can be used as a marketable product or service (200 words) *

Plain text please

Who do you think will buy the product or service and why? (200 words) *

What competitive advantages do you think the technology has over current products or services? (200 words) *

Plain text please

What are your plans for Customer Discovery? (200 words) *

Plain text please

What is the status of your IP and IP protection? *

What institution (university, company, agency, etc.) are you affiliated with? *

If affiliated with GW, which school, department or organization are you a part of?

If affiliated with GW, which best describes you?

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