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* 1. Agency Contact Information

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* 2. Agency Website

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* 3. What is your organization's mission?

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* 4. Agency Budget Information.

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* 5. Give a brief description of the new initiative or venture idea you wish to pursue:

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* 6. What are your mission objectives for this new initiative?

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* 7. How would this new initiative fit into your strategic plan?

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* 8. What are your financial objectives for this new initiative?

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* 9. What else are you hoping to achieve by being a participant?

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* 10. How do you believe your organization is prepared for managing a new business model?

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* 11. What makes your organization an excellent candidate to participate in the Innovation Catalyst?

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* 12. Application acknowledgement and electronic signature: We have read the requirements of participation in this program and agree to follow the expectations of the catalyst program to our full potential.

Please type your first and last name here along with the date as your Electronic Signature. Example: Jane Doe 7/25/2012

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