Exit this survey Global Impact Award Entry Form Question Title * 1. Please enter the name of your project/venture/organization as you would like it to appear on competition materials: Question Title * 2. Please provide a one-sentence description of your project/venture/organization as you would like it to appear on competition materials: Question Title * 3. Please list contact info for team members. For WUSTL affiliation, please use "student," "postdoc," or "alum." If you have more than 4 team members, please email their names and contact information to sces@wustl.edu. Team Member #1: Name: * WUSTL Affiliation: * Role/Title on Team: Email Address: * Phone Number: * Question Title * 4. Team Member #2: Name: WUSTL Affiliation: Address: Email Address: Phone Number: Question Title * 5. Team Member #3: Name: WUSTL Affiliation: Address: Email Address: Phone Number: Question Title * 6. Team Member #4: Name: WUSTL Affiliation: Address: Email Address: Phone Number: Question Title * 7. What is your date of incorporation? Please use MM/DD/YYYY format. Question Title * 8. What is the structure of your organization? Sole Proprietorship or Partnership Corporation Limited Liability Company (LLC) Low-profit Limited Liability Company (L3C) Tax-exempt organization under Section 501(c)(3) of the US Internal Revenue Code Other (please specify) Question Title * 9. Please select your business model: For profit Nonprofit Hybrid for/nonprofit Question Title * 10. How much money have you raised, including debt, equity, grant, or prize funding? less than $50,000 $50,000 - $100,000 $100,000 - $250,000 $250,000 - $500,000 $500,000 - $1,000,000 Over $1,000,000 Question Title * 11. Please list any press mentions, and provide links where available. Question Title * 12. Do you have a proof of concept? Briefly explain. Next
