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Required format:

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/^((02([-\/])29\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\/])(0[1-9]|1\d|2[0-8]))|((0[13-9]|1[012])([-\/])(29|30))|((0[13578]|1[02])([-\/])31))(\11|\15|\19)\d{4}))$/

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CzkUmemk83XE6HIVR3iSsuXq2y8HQSfRZqsXpQZT6uT4huHRn34f4BxEQwY7QHx5G82rw5PnCigTVv8JYDqZidAIVJTF

Project Intake - BIP Corp Fall 2022

Please provide information in the fields below. If you have any questions, please contact OCTRI Innovation Alliance Manager, Melissa Mudd muddm@ohsu.edu.

Thank you!

Full Name of the Project Lead:

* must provide value

Project Lead email

* must provide value

How did you first learn about this course?

General email announcements

Direct outreach by program

Recommendation of former participant

Other (please specify below)

Other: specify how you learned about this course

* must provide value

Do you have an idea/project in mind for this course?

* must provide value

Yes

No: I am interested in joining an enrolled project

reset

Technology/company name or working title of your innovation:

* must provide value

Select the type of technology/solution that best describes your project:

* must provide value

Other, specify:

* must provide value

Please provide a short description of your project or technology, your current work to date, and your goals for commercialization (startup, license, unsure):

* must provide value

Expand

Please indicate the stage/current status of your solution, select all that apply to the focus of your current efforts:

* must provide value

Idea generation

Design

Prototype development

Seeking capital investment

Production / Sales

Other (please specify)

Please specify the current status of your solution:

Have you participated in an I-Corps program in the past?

* must provide value

Please specify year(s) you participated in I-Corps training:

* must provide value

Please specify other I-Corps based training and year:

* must provide value

Please describe the customer/market for your technology/solution and what work you have done to validate this market, if any:

* must provide value

Please indicate your technology/innovation IP ownership:

* must provide value

Have you considered forming a company to commercialize your product?

* must provide value

Have you considered an SBIR/STTR for this project?

* must provide value

How many team members are on your team, not including yourself?

* must provide value

Full name of team member 1

* must provide value

Email of team member 1

* must provide value

Full name of team member 2

* must provide value

Email of team member 2

* must provide value

Full name of team member 3

* must provide value

Email of team member 3

* must provide value

Full name of team member 4

* must provide value

Email of team member 4

* must provide value

Full name of team member 5

* must provide value

Email of team member 5

* must provide value

Full name of team member 6

* must provide value

Email of team member 6

* must provide value

Full name of team member 7

* must provide value

Email of team member 7

* must provide value

Full name of team member 8

* must provide value

Email of team member 8

* must provide value

Full name of team member 9

* must provide value

Email of team member 9

* must provide value

Full name of team member 10

* must provide value

Email of team member 10

* must provide value

Full name of team member 11

* must provide value

Email of team member 11

* must provide value

Full name of team member 12

* must provide value

Email of team member 12

* must provide value

Full name of team member 13

* must provide value

Email of team member 13

* must provide value

Full name of team member 14

* must provide value

Email of team member 14

* must provide value

Which of the following statements is most reflective of your project's commercialization readiness at this time?

Would you like BIP Corp staff to suggest team members for the duration of the course?

Yes

reset

Are there specific areas of expertise or background knowledge that would be most helpful for your project/innovation? Please list.

Expand

BIP Corp will make every effort to match interested individuals with an enrolled project. Matches are based on the expertise and interest of individuals and enrolled project needs.

Please briefly explain your background/expertise and general topic area(s) you are interested in.

* must provide value

Expand

Are you currently as a student?

* must provide value

Yes

reset

If yes, please provide the year, field of study, and describe how BIP Corp will impact your education or career path:

* must provide value

Expand

By selecting this box you agree to:

Attend and participate in Introduction and Customer Discovery course events
Attend 30-minute office hour sessions with instructors during weeks 2 and 4
Conduct 30 customer discovery interviews over the 5-week course
Complete all course evaluations

* must provide value

I acknowledge that I/my team will participate in all of the above

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.