Please fill out the questions to the best of your knowledge.

Questions with * are mandatory.

Answers are limited to 2,000 characters each.

You cannot save a partially filled out application. You may print a copy for your own records prior to hitting submit.

To preview the questions or work offline, download this PDF version.

* 1. First name

* 2. Last name

* 3. Email address

* 4. Phone number

* 5. City/town

* 6. State/province

* 7. From what institution, in what state, did you graduate?

* 8. Which of the following best describes your primary affiliation over the past year?

* 9. What are your primary areas of technical expertise? (Please select all that apply.)

* 10. What are your secondary areas of technical expertise? (Select up to two areas.)

* 11. What is the title of your technology?
This title should describe technology you intend to propose for CRI, not your personal professional title.

* 12. What is your primary technology focus area? (For more information please see the DOE Advanced Manufacturing Office’s Multi-Year Program Plan.)

* 13. What is the industry sector of the proposed technology (Select all that apply.)

* 14. What key words are associated with your technology?
Use commas to separate.

* 15. Has this project received outside funding? (Select all that apply.)

* 16. How did you hear about Chain Reaction Innovations? (Select all that apply.)

* 17. If applicable, who referred you?

* 18. Have you previously applied to one of the Lab-Embedded Entrepreneurship Programs? (Select all that apply.)

* 19. Did you attend a prospective applicant webinar prior to the application period? (Check all that apply.)

* 20. Personal and Company Twitter Handles

* 21. Link to company website, if available

* 22. In what state did you originally launch your start-up in?

* 23. Will you have raised more than $1M in private funding at the time of entry into the CRI program?

* 24. Are you a first-time founder?

* 25. Are you a U.S. citizen or permanent resident?

17% of survey complete.