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* 1. What are your full name and company email? Specify like this: Jane Doe, jane@me.com.

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* 2. What is your company website?

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* 3. Are you a digital health, med tech or health tech start-up looking for development funding of between $36K and $2.5M?

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* 4. What stage is your startup in?

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* 5. Do you have presence in the EU/EEA?

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* 6. Does your management have prior industry experience (of at least 5 years combined) OR have raised a professional round of financing before?

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* 7. Do you have traction defined as one of the following?


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* 8. Description of my company (max 140 characters) Structure: Our [product/service/SaaS/app (be specific)] helps [customer segment], who want to [problem] by [doing what - input] to [do what - output].Uber sample: Our app helps everyone, who wants to take a ride, by just pushing a button to get a car in 5 min, which takes you anywhere you want to go from whenever you are.

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* 9. Is your business generating revenue?

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* 10. What do you want to use EU public funds for?

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