Phase I Application

This is an introductory survey to help us understand your needs and goals.

 

Application Overview

 
 
 
mm/dd/yyyy
 
 
 

 

 

Have you conducted the following:

 

Understanding potential customers, how large the market is, competitors, price points, advertising etc.

 

Understanding the costs for design & development, technical assistance, manufacturing, suppliers, labor etc.

 

Understanding potential risks and have mitigation plans to address them.

 

What is your projected timeline, objectives and deadlines?

 

Have you explored and understand or have a plan to protect your IP?

 

Do you have an LLC, 501c3 or similar already established?

 

If so, please attache below

 
 

If you selected "See below for more information" please describe that here.

 

 

Innovation Information

 

Provide a brief description of your innovation:

 
 
 
 
 
 
 
 
 
 

 

Institutional Impact

 

Please choose from one of the following:



Level 1 - Minimal Impact


“The study will not require use of institutional resources. Staff commitments will be covered partially or in full from accompanying funds and do not exceed 0.1 FTE per staff member. There will be no direct patient interaction, no interventions, and no use of identifiable data."



Level 2 - Moderate Impact


"The study does not require access to identifiable data or include an intervention arm, but it does include 1 or more of the following.


Direct patient interaction, use of non-critical hospital resources with reimbursement at market rate, staff commitments with partial or full reimbursement of >0.1 FTE but < 0.5 FTE."



Level 3 - Significant Impact


"The study does not require access to identifiable data, but it does include 1 or more of the following.


An interventional arm or staff commitments of > 0.5 FTE or without reimbursement."



Level 4 - Severe Impact


"The study includes access to identifiable data or includes unrecoverable costs in resources or manpower."

 

 
 
 

 
Drop your files here