Preliminary Application Form

This form is designed to gather initial information about your company and its innovations / solutions. Selected applicants will be invited to submit a comprehensive application.

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* 1. Company Information

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* 2. Contact Information

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* 3. Where is Your Company Based?

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* 4. Type of Company

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* 5. Funding Stage

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* 6. Amount of Funding Secured to Date:

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* 7. Current Runway (months):Your response helps us understand your funding timeline – it is NOT a selection criterion

Solution Overview

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* 8. Brief Description of Your Solution (100 words or less):

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* 9. How will your solution strengthen health resiliency and security or address unmet patient or health system needs?
(Select all that apply)

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* 10. Which Innovation Focus Area(s) Does Your Solution Address?
(Select all that apply)

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* 11. What is the Status of Your Solution’s Development?
(Select one)

Market Readiness

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* 12. Who Are Your Target Users or Beneficiaries?
(Select all that apply)

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* 13. Who is Your Target Paying Customer?
(Select all that apply)

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* 14. What Problem Does Your Solution Address? Why is it Important?
(150 words or less)

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* 15. What is Your Solution’s Unique Value Proposition?
(100 words or less)

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* 16. Have You Conducted One or More of the Following to Demonstrate Traction?
(Select all that apply)

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* 17. What is Your Solution’s Current Status in the U.S. Market?

Accelerator Program

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* 18. Why Are You Interested in Joining the HealthTech Hub Accelerator Program and How Would You and Your Company Benefit?
(250 words or less)

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* 19. Please Indicate Your Preferred Date for Participation in the Onsite Programming:

Submission Statement
By submitting this application, I confirm that the information provided is accurate to the best of my knowledge and that I understand selection for advancement to the HealthTech Hub Accelerator Program’s Comprehensive Application phase is solely at the discretion of the Health Tech Hub team.

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* 20. Name and Title:

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