INTRODUCTION AND COMPANY INFORMATION

PLEASE READ BEFORE YOU BEGIN YOUR SUBMISSION:

The information entered in this form will be used for the USDD and will NOT be made publicly available. The information you submit will allow us to send you information on the companies in your specified technology areas.

- This form is for Fortune 500 and Global 1000 corporate representatives ONLY to apply for a slot in the Corporate Selection Committee.
- By filling out this form, you will be part of the Selection Committee and will be provided a copy of company profiles in your technology area.
- We will contact you to schedule a conference call as a follow-up to your submission.
- You can change the answers to your submission form provided that you access the form from the same device used to start the submission and only before you click the “Click to Submit” button at the end.

For more information about the USDD visit http://ncet2.org
For questions about this form or the USDD email Ria P. Ancheta-Adrias at riaancheta@ncet2.org

* 1. Company Name

* 2. Your Information

* 3. Company description or a link to your company description online (this company description will be posted online at http://ncet2.org)

* 4. Company Location

* 5. Technical Area: Select all that apply. The next five questions will allow you to select subcategories for each of your technical area.

* 6. Pharmaceuticals and Medical (Select all that apply)

* 7. Advanced Manufacturing (Select all that apply)

* 8. Clean Tech and Chemicals Subcategories (select all that apply):

* 9. ICT Subcategories (select all that apply)

* 10. Consumer-Facing Platforms (select all that apply)

* 11. Select the technology stage/TRL level of companies you look for (select all that apply)

* 12. Would you like to describe further the technology level/readiness as it applies to your industry?

* 13. What stage of company do you usually work with/are interested in (ex. seed-stage, early-stage, series A)

* 14. What type of assistance do you provide startups?

END OF FORM
(CLICK ON "CLICK TO SUBMIT" BELOW TO COMPLETE SUBMISSION)

- You can change the answers on your submission form provided that you access the form from the same device used to start the submission and only before you click the “Click to Submit” button at the end.
- Expect a follow-up email from us 24-48 hours after your submission.
- For questions about this form or the USDD, email Ria P. Ancheta-Adrias at riaancheta@ncet2.org

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