General Information and Instructions

Application process:
1. Please submit this completed application 
2. Complete all questions
3. If you have a pitch deck or executive summary, email to paul@fitzpatrickconsultants.com
4. We will email you to schedule your interview after we receive your application.

*Please note that your application will be reviewed by both the BioStartup Planning Team and interview committee.


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* 1. Applicant's Name

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* 2. Applicants Business Name

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* 3. Address (please include town and zip)

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* 4. Email

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* 5. Phone

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* 6. Business URL (if applicable)

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* 7. Applicants LinkedIn URL

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* 8. Year Company Founded

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* 9. Target Business Sector

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* 10. Please tell us about your idea or company in a single paragraph

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* 11. The Problem - please describe the problem you are addressing

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* 12. Solution Description – please describe your solution to your stated problem

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* 13. My company is

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* 14. Does your solution need regulatory approval?

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* 15. Is there reimbursement for your solution?

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* 16. Do you have Intellectual Property rights?

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* 17. How is your company organized?

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* 18. Please tell us briefly about your cofounders and management team

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* 19. How many employees do you have? (enter 0 if none)

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* 20. What are you hoping to gain from participating in the BioStartup
Accelerator Program?

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* 21. Participation and payment agreement

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