ACETECH Market Expansion Program 2012

Welcome to the online ACETECH Market Expansion Program application form. The information collected in this survey is strictly confidential and will only be used by ACETECH personel to review your application. You will be contacted by an ACETECH representative to set-up an appointment with a venture advisor to discuss your application

1. Company Name

Company Name

2. Applicant's Name

Applicant's Name First
Last

3. Applicant's email address

Applicant's email address

4. Website

Website

5. Year established

Year established

6. Are you the founder or CEO of the company?

Are you the founder or CEO of the company? Yes

7. Is the company product or service oriented?

Is the company product or service oriented? Product

Service

Service funding product development

8. Please select the proposition that best describes your company's status

Please select the proposition that best describes your company's status Validating product or service idea - No sales at this time

Prototype or initial product - One or a few early sales

Focused on dominating one market segment

Selling to multiple segments - Not the market leader in any segment

Leader in a market segment - Focusing on penetrating new segments

9. Origin of product / service

Origin of product / service Identified customer / market need and created a product

Spun-out of Academia

Spun-out of consulting / custom development

Spun-out from prior company

Started with technology, then sought market for it

Other (please specify)

10. Product / Service description

Product / Service description

11. Are you generating revenue from your customer(s)?

Are you generating revenue from your customer(s)? Yes

12. Please rate the following business challenges on a priority scale of 1 (very low) to 5 (very high)

	Very low	Low	Medium	High	Very high
Strategic direction	*Please rate the following business challenges on a priority scale of 1 (very low) to 5 (very high) Strategic direction Very low	Strategic direction Low	Strategic direction Medium	Strategic direction High	Strategic direction Very high
Lack of adequate funding	Lack of adequate funding Very low	Lack of adequate funding Low	Lack of adequate funding Medium	Lack of adequate funding High	Lack of adequate funding Very high
Management experience and team strength	Management experience and team strength Very low	Management experience and team strength Low	Management experience and team strength Medium	Management experience and team strength High	Management experience and team strength Very high
Organizational processes and structure	Organizational processes and structure Very low	Organizational processes and structure Low	Organizational processes and structure Medium	Organizational processes and structure High	Organizational processes and structure Very high
Technical or regulatory hurdles impacting product development	Technical or regulatory hurdles impacting product development Very low	Technical or regulatory hurdles impacting product development Low	Technical or regulatory hurdles impacting product development Medium	Technical or regulatory hurdles impacting product development High	Technical or regulatory hurdles impacting product development Very high
Marketing and sales	Marketing and sales Very low	Marketing and sales Low	Marketing and sales Medium	Marketing and sales High	Marketing and sales Very high
External environment / competition	External environment / competition Very low	External environment / competition Low	External environment / competition Medium	External environment / competition High	External environment / competition Very high
Insufficient company growth	Insufficient company growth Very low	Insufficient company growth Low	Insufficient company growth Medium	Insufficient company growth High	Insufficient company growth Very high
Managing rapid growth	Managing rapid growth Very low	Managing rapid growth Low	Managing rapid growth Medium	Managing rapid growth High	Managing rapid growth Very high

Other (please specify)

ACETECH Market Expansion Program 2012 - Application

ONLINE APPLICATION