Company Name & Business Details Comany Name Headquarters Address Street Address Address Line 2 City State Zip Code Website Prefix First Last Suffix Email Phone Signiture Sign above Do You Have An Organizational Structure? Yes No, We Have a Hiring Strategy No Please tell us about your team: Exhibit A: Company Information and Business Plan Annual Revenues to Date (if any) Describe any Capital or Debt on the business: List any Grants received: Re-order Grant Name or Offereor Brant Amount Weight Operations Grant Name or Offereor Brant Amount Item weight Add more items more items Describe Your Business Plan and Organizational Strategy Exhibit B: Product Description How would you best describe your product? What or who is your target market? Identify Area or Field of Product? What or where is the unmet need and/or what is your product's unique proposition? Exhibit C: Describe Your Innovation Readiness and Product Feasibility Patent (IP) work completed? Yes No Provisional Patent filed? Yes No Regulatory requirements known? Yes No Regulatory pathway completed? Yes No Market Analysis available? Yes No User Needs Assessment available? Yes No QMS (provide overview) CAD Files supporting Technology Plan (if available) One file only.500 MB limit.Allowed types: gif jpg jpeg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 mp4 ogg wav bz2 dmg gz jar rar sit svg tar zip. What are your biggest risks? What risks have you mitigated? Are Design constraints addressed? Yes No If so, please describe Design Testing, Verification and Validation completed? Yes No If so, please describe how Markets and Manufacturing Identification? Yes No If so, please describe them Value Analysis completed? Yes No Supply Chain Strategy completed? Yes No Cost of Goods Sold completed? Yes No Please Outline Exhibit D: Describe Your Manufacturing and Technology Readiness Is there a current Manufacturing process? Yes No Produced in-house? Which components of the product? Outsourced? Existing Plan or Process: Laboratory - exists? Please describe: Any Manufacturing Constraints known? Please describe your biggest need for advancing manufacturing towards commercialization: How many suppliers have been contacted and/or are aligned with your product? What technologies, if any, do you expect to require for production in your current and next phases? Is this technology proprietary? Yes No What is the cyber security plan? Are CAD files available for the product? Yes No What (quantity) has been produced to date? Where was this production completed and by whom? Who has the completed products? What is the estimated part count for the finished product? Has a high-level production process flow been mapped (attach if yes) Yes No Please attach Process Flow One file only.500 MB limit.Allowed types: gif jpg jpeg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 mp4 ogg wav bz2 dmg gz jar rar sit svg tar zip. Has a test process been created for your product? Yes No Was it used on products produced to date? Yes No Exhibit E: Describe Your Commercialization and Funding StrategyCommercialization Strategy Please describe your commercialization strategy: Address your plan for short term to long term ownership of product: If you were to receive support from the MedTech Center of Excellence and Build2Scale Product Funding, how would you anticipate using those funds? Funding Strategy and Investor Readiness Level How is your product and/or company currently funded? If Grant Funded - Please provide more detail: If Other Source of Funding - Please provide more detail: How did you hear about MedTech Center of Excellence? How did you hear about The MedTech Center of Excellence? GaMEP ATDC GCMI GaBIO GA Economic Development Atlanta Chamber of Commerce Global Health Other Any additional information you'd like to share for the review team? CAPTCHA Math question (4 + 3 =) Solve this simple math problem and enter the result. E.g. for 1+3, enter 4. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
