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SBIR/STTR Assessment Form
SBIR/STTR Assessment Form
Please fill out the following to help us understand how we can best help you with your SBIR/STTR plans.
Name
*
First
Last
Email
*
Phone
*
Company/Organization (if formed)
*
In what year was the company formed? (if appropriate)
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
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Louisiana
Maine
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Michigan
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Ohio
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South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
Eligibility Requirements
Does your company fulfill the following SBIR/STTR eligibility requirements?
Is your company:
*
< 500 employees
> 51% owned by individuals
Are the owners of your company US citizens or Permanent Residents?
*
Yes
No
Do you have company-controlled research space?
*
Yes
No
No but we plan to obtain at the time of award
Briefly describe your company facilities:
Have you identified a Principal Investigator (PI) who will be 51% employed by the company at the time of award?
*
Yes
No
We plan to do an STTR and have identified a PI at a collaborating institution
Briefly describe the background and qualifications of the PI:
*
Tell us about your SBIR/STTR Project
Please answer the following questions that relate to your SBIR/STTR project and related technology/product:
Which Federal Agency(ies) do you plan to apply to?
*
National Institutes of Health (NIH)
National Science Foundation
Dept. of Defense (DoD)
Dept. of Energy
U.S. Dept. of Agriculture (USDA)
Dept. of Transportation (DoT)
Dept. of Education
Other (please specify):
Briefly describe the technology/product to be developed:
*
Who is the intended customer for your product?
*
Previous SBIR experience
Have you ever applied for SBIR/STTR before?
*
Yes
No
Have you received any SBIR/STTR awards?
*
Yes
No
Briefly describe any previous/current SBIR/STTR awards:
*
How would you describe your proposal-writing experience?
*
No previous proposal-writing experience
I've helped people write proposals
I've written proposals before but not SBIR/STTRs
I've written unsuccessful SBIR/STTRs
I've written successful SBIR/STTRs
Have you attended any SBIR/STTR training? If so, please describe briefly.
*
Have you identified an Agency and solicitation? What is the submission deadline?
*
Is there anything else you would like to add?
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