Health Innovation Hub: Life Sciences '19

1. First Name
2. Last Name
3. Company Name
4. Company Street Address:
5. City:
6. State:
7. Postal Code:
8. Website
9. Applicant Email:
10. Applicant Work Phone: Can be the same as cell phone
11. Applicant Cell Phone:
12. One-Line Company Description
13. Professional Bio of Applicant
14. Who referred you to Springboard?
15. What value do you hope to gain from participating in Springboard?
16. Those selected to participate in the Health Hub: Life Sciences track are required to pay a $5,000 program fee.
17. Those companies that advance past the initial online screening will be invited to one of our Regional Interviews - Please confirm your preferred location: Dates for each session to be determined. We strive to accommodate all requests.

1. Company Description
2. Industry
3. If "other", please list
4. Therapeutic Area(s)/Sub-industry(ies)
5. Number of Full-Time Employees
6. Date company was founded
7. Company stage
8. Those who apply must have significant decision-making authority and equity ownership relative to the rest of the management team. List the % Equity Ownership of the applicant and % Equity Ownership of the Management Team. (Ex. management team holds total of 50% equity: CEO, 35%, CTO 20%, COO 5%)
9. List previous participation in Accelerators and Incubators

1. Who is on the Core Management Team and what is their expertise relative to this business?
2. Board Members and Advisors
3. Lawyer (indicate if patent lawyer, corporate counsel, SEC/financing, regulatory, employment, immigration, etc.)
4. Accountant
5. Banker

1. What is the Market you are addressing, and how big is it?
2. What is the incidence and prevalence of the disease your product treats/diagnoses?
3. Who are your Competitors?
4. What sets your product apart from the Competition?

1. List your Intellectual Property and how it is protected (including future strategy)

1. What is your business model?
2. What is your partnering strategy, or how do you otherwise expect to take your solution into the market?
3. Describe your regulatory pathway and where you are now in that process.
4. Is your technology a substitute for a product that is already being reimbursed and used in established treatment/diagnosis protocols?

1. Describe your recent company achievements and milestones
2. What are the next milestones you need to achieve?

1. Equity Capital Raised to Date (in Millions USD)
2. Grants/non-dilutive Capital Raised To Date (in Millions USD)
3. Capital Seeking (in Millions USD) and when you expect to close
4. What round of capital are you seeking?
5. Current Investors
6. Pre-money Valuation (in Millions USD)
7. Current Annual Revenue Run Rate (in Thousands USD)
8. Monthly Burn Rate (in Thousands USD)
9. What are you going to look like after you spend the money you are raising now?

1. When do you anticipate an exit and who are the likely acquirers? If you do not anticipate an exit by acquisition, what is your exit strategy?
2. What do you believe are the biggest risks to an investor considering an investment in your company?

1. Investor Pitch Deck (Max file size 30MB.) Please upload in .ppt, .pptx, or .pdf format. This will be reviewed by the online screeners in combination with the other parts of your application - there will be no opportunity to pitch alongside this deck during the online review process. If selected to advance to the interview stage, you will be permitted to send a new deck, which you will pitch with at the in-person interview session for 10 minutes. (This deck will be collected after interview decisions have been made.)
2. Executive Summary (Max file size 30MB.)
3. Financial Projections (Max file size 30MB.)
4. What name will appear on the card used to process application payment? If you experience difficulty submitting payment and/or finalizing your application, please contact Mary Jackson at mary@sb.co or (202) 242-6282