Tech Needs Assessment

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* 1. What technology is your company developing?

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* 2. What is the name of your company?

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* 3. List the primary decision maker at your company.

Name: *

Company: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

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* 4. Who holds the highest engineering or technical position at your company?

Name

Title

Education Level

Phone

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* 5. Where is your company incorporated and where is it's primary place of business?

New York, NY --> New York, NY

Other (please specify)

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* 6. What do you need to grow?

Need training in basic entrepreneurial concepts.

Need access to investment community.

Need SBIR assistance.

Need help developing a prototyping and manufacturing strategy.

Want to get products to market faster.

Want access to a larger network of technologists and strategic partners.

Need help protecting my intellectual property.

Need help improving sustainability or 'greening' my products.

Other (please specify)

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* 7. What stage would you say your technology is in on the path to commercialization?

Concept / Thought / Idea

Proof of Concept / Prototype

Product Beta

Final Candidate / Commercialized

Concept / Thought / Idea

Proof of Concept / Prototype

Product Beta

Final Candidate / Commercialized

Other (please specify)

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* 8. What is your primary NAICS / SIC code?

NAICS

SIC

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* 9. How much financing has your company raised to date?

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* 10. What type of financing is your company looking for in the near future?

Seed Loan

Seed Equity

Series A Equity

Receivable or Inventory Financing

Federal or State R&D Funding (SBIR/STTR)

Other (please specify)