Full Name of the Project Lead:
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Project Lead email
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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
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Do you have an idea/project in mind for this course?
* must provide value
Yes
No: I am interested in joining an enrolled project
Technology/company name or working title of your innovation:
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will be used as Team Name for the course
Select the type of technology/solution that best describes your project:
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Diagnostic Drug/Biologic Education/training-related product Medical device Research services Software application/Health IT Other (specify below)
Other, specify:
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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
Please indicate the stage/current status of your solution, select all that apply to the focus of your current efforts:
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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?
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Yes - completed a local program (e.g. offered by the CTSA) Yes - observed/participated in some local training but did not complete No Other - please specify below
Please specify year(s) you participated in I-Corps training:
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Please specify other I-Corps based training and year:
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Please describe the customer/market for your technology/solution and what work you have done to validate this market, if any:
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Please indicate your technology/innovation IP ownership:
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University owned IP Student owned IP External IP Unknown None
Have you considered forming a company to commercialize your product?
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Yes No There is already a company
Have you considered an SBIR/STTR for this project?
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I already have an SBIR/STTR award for this project I submitted but did not get funded I submitted but do not yet know the outcome of the submission I plan to submit in the future I do not have an SBIR/STTR award and do not plan to apply at this time N/A - I did not know these programs existed
How many team members are on your team, not including yourself?
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Teams are encouraged, but not required. Teams (2+) generally report increased learning outcomes and value-added to their innovation from this condensed course.
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?
Our project is ready for commercialization Our project is not yet ready for commercialization We aren't yet sure that our project is commercializable
Would you like BIP Corp staff to suggest team members for the duration of the course?
Yes
No
Team members are optional, but may help reduce workload.
Are there specific areas of expertise or background knowledge that would be most helpful for your project/innovation? Please list.
BIP Corp will only match individuals to projects if appropriate and both parties agree to the pairing.
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.
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Are you currently as a student?
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Yes
No
If yes, please provide the year, field of study, and describe how BIP Corp will impact your education or career path:
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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
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