1.
First Name of Applicant:
Last Name of Applicant:
2.
Street Address:
City:
State:
Zip
Code:
3.
E-mail:
4.
Phone:
5.
Web Address:
6.
Name of Organization
7.
How did you hear about the INVEST program?
8.
Type of Business
(required if #6 above is answered)
9.
Number of Full Time Employees:
10.
Do you have intellectual property ownership and/or exclusive rights to make business and legal decisions concerning the technologies/products receiving funding? 11.
Please explain your legal authority for decision making: (required if "Yes" is selected for #10 above)
12.
Do you have any existing business relationships regarding this product or technology?
13.
If yes, please explain the nature of the relationship, and with whom: (required if "Yes" is selected for #12 above)
**Additional pages may be added if necessary** You will have the opportunity to upload a file containing the additional pages after this form is submitted.
14.
Has a patent search been performed for this product/technology?
15.
If yes, who performed the search? (required if "Yes" is selected for #14 above)
16.
What were the results/conclusions? (required if "Yes" is selected for #14 above)
17.
Have you applied for a US patent?
18.
Have you applied for an international patent?
19.
If yes, what is your patent application number(s) or issued patent number(s)? (required if "Yes" is selected for #17 or #18 above)
From inception to date, please give an estimate of the following:
20.
Total man-hours spent on research, testing and development:
21.
Total money invested in research, testing and development:
$
22.
If requested, could you provide samples of the product/technology?
23.
What is the scale of your research, testing and development (bench top, lab-scale, pilot scale, pre-commercial, etc.)?
24.
In your estimation, given the current stage of your product/technology development, how much additional funding is needed for your product/technology to reach the market?
$
25.
Have you received or applied for any state or federal funds to develop this project?
26.
If yes, what state and/or federal program and how much did you receive? (required if "Yes" is selected for #25 above)
27.
The Indiana Soybean Alliance has made 40,000 available through the INVEST program for this funding round. How much do you request through the INVEST program?
$
Product/Technology Summary
When answering the following questions, please keep in mind that ISA is looking for products and technologies that are relevant to soy and have marketing potential. ISA wants to know how your product or technology incorporates soy, what the product or technology will do, what target markets the product will serve, the current stage of development, and the key challenges involved with bringing the product or technology to the market.
28.
In 100 words or less please provide a summary, in lay terms, of your product or technology. The summary should include, at a minimum: product/technology development information; benefits; challenges; and what INVEST would help you accomplish.
29.
In 300 words or less, please provide a technological, scientific summary of the nature of the product/technology.
When you click on the "Continue with Submission" button below, you will be asked to upload files that contain your business plan and your projected budget. If you do not have these files ready, you can click on the "Save Information to Continue Submission at a Later Time" button below.
PLEASE NOTE: If you do not click on one of the buttons below the information you entered above will NOT be saved.
