TechGROWTHfund.com: Registration Form

Application Form

Please complete the following information to set up an advising session with a TechGROWTH Fund professional. Once submitted, you will be contacted within a week to schedule your session.

NOTE: You must complete all required fields of both the “Company Info” AND the “Business Info” sections and click “SUBMIT” at the end of the form to complete your application.

* 1. Which of the following best describes your business experience? a) This is my first time starting a business
b) I have some experience starting a business
c) I have extensive experience as an Entrepreneur

* 2. How often do you use a computer? a) Rarely
b) 1-2 times a week
c) Several times a day

Company Information
* indicates a required field

Company Name*

Address 1*

Address 2

City *

County*

State*

Zip *

55555

Phone Number*

(Please use the format 555-555-5555)

FAX Number

(Please use the format 555-555-5555)

Website Address

Contact Person

First Name*

Last Name*

Job Title*

Email*

Phone Number*

(Please use the format 555-555-5555)

FAX Number

(Please use the format 555-555-5555)

Contact Address

Same as above
Address*
City*
State	Zip *	(Please use the format 55555)

I would like to become a registered member. Registered members use the contact person's email address as the user login name and the password submitted below to make revisions and track their application.

Registration is optional. Once you become a registered member, you do not need to re-register to submit additional Registration Form s.

Business Information
* indicates a required field

TechGROWTH Fund only provides operating assistance and funds to businesses having economic impact in one of the 19 counties in Southeast Ohio.
*County:
*Are you located or operating in one of the counties?

Yes
No

*Provide a brief summary of your company, product or idea, including a description of your market. Also describe what is different or unique about your technology, product or service. (8000 characters or less) :

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Please attach documents providing additional information about your business. You may want to include documents such as marketing brochures, informational graphics, your business plan or white papers. Attaching additional documents is optional.

You can upload up 8 different files at once. Please use the "Add" button to add more select boxes or use the "Delete" button to reduce the number of selected boxes.

*Technology Area:

Other:

*What financing stage is your company in?
Imagining – Technology and business model are conceptual, but yet developed.
Incubating – Technology and business model are in development, but products are not yet for sale.
Demonstrating – Prototype technology can be shown and orders for product can be taken.
Market Entry – Product shipping.

*How much cash has been invested in the business to date? (Do not include foregone salaries or in-kind contributions.)

*Where did the investment come from?

Angel Investor
Bank
Friends and Family
Self
Venture Capital Fund
Positive Cash Flow
None
Other (please specify)

*What type of assistance are you seeking for your business?

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*(Only required, if you are seeking funding) If you are seeking funding, how much money are you seeking?

*If your company relies on intellectual property ("IP") such as patents or trademarks for its competitive advantage, does the company (versus an individual) own or have exclusive license to the IP?

Yes
No
Not Applicable

*(Only required if your Company relies on IP) Describe how your company relies on intellectual property. If applicable, please list patent, trademark and/or copyright registrations (with jurisdiction and registration numbers):

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*Briefly describe the stage of development of you product or service.

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*How is your business structured?

*List the names and titles of the company's management team or List the names and roles of others involved in your company.

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*TechGROWTH offers:

No fee business advisory services
Competitive small grants (A few thousand to $25,000 range).
Highly competitive pre-seed investment opportunities ($200,000 – $300,000 range).

If you wish to be considered for pre-seed investment, we will ask for access to the company’s legal documents (including patent or license information) and will ask to contact many of your collaborators, customers (or potential customers) and personal references. Is this something you will agree to?

Yes
No
Not Sure

*How did you hear about TechGROWTH Fund?

Ohio University acknowledges the contribution of the State of Ohio, Department of Development and the Third Frontier Commission, which provided funding in support of the TechGROWTH Ohio project.