CT Next Assessment Form

We encourage you to view our “How to Apply for SBIR Accelerate CT” webinar recording prior to completing the assessment form. Click to view the webinar and slides.

If you are applying for SBIR Accelerate CT, please fill out the following assessment form to help us understand how we can best help you with your SBIR/STTR plans. If you have questions or need additional information, please email info@bbcetc.com or call 734-930-9741.

Name*
First Last
Preferred Email*
Phone*
Company/Organization (if formed)*
What is your title within the company?*
In what year was the company formed? (if appropriate)*
Address*
Street Address Address Line 2 City State ZIP Code
What is your NAICS code? (To find your company’s NAICS code, search: http://www.naics.com/search)*
Please indicate if your company is:*
- Women owned
- Minority owned
- Veteran owned
- Other
Are you collaborating with other organizations on your proposed SBIR/STTR project (e.g., academic laboratories, etc.)?*
- Yes
- No
If not, have you identified prospective collaborators?
- Yes
- No
If yes to either of the above, please identify:
In the past 12 months...
Has the company received any other funding from Connecticut Innovations or any state partners or accessed other State of Connecticut resources? (Examples include but are not limited to awards through: CI’s Pre-Seed Fund, Small Business Innovation and Diversification Program, Technology Talent Bridge program, Eli Whitney Fund (equity investments), and SBIR Acceleration and Commercialization Program; SBDC offices, incubator grants, CTNext, SCORE and DECD’s Small Business Express Program.*
- Yes
- No
If yes, please name the funding organization(s) or agency(s) and the amount(s).
Has the applicant or any of the company principals been sued in civil court for a debt in the past 12 months?*
- Yes
- No
If yes, please explain:
Does the applicant or company owe any outstanding city/town/municipal taxes for the past 12 months? (This includes both business and residence.)*
- Yes
- No
If yes, please explain:
Federal Eligibility Requirements
Does your company fulfill the following SBIR/STTR eligibility requirements?
Is your company:*
- <500 employees
- >51% owned by individuals who are US citizens and/or permanent residents
- Majority owned by another small business that is majority owned by US citizens and/or permanent residents
- Majority owned by institutional investors (e.g, venture capital, hedge funds)
- A subsidiary or affiliate of another organization
Do you have company-controlled research space?*
- Yes
- No
If no, have you identified space that you will move into at the time of award?
- Yes
- No
If yes to either of the above two questions, please describe your company facilities and identify their location:
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 (NSF)
- Dept. of Defense (DoD)
- Dept. of Energy (DoE)
- U.S Dept. of Agriculture (USDA)
- Other (please specify)
Please specify any other agencies to which you plan to apply:
Briefly describe the technology/product to be developed:*
What is the ownership status of your IP?*
- My company owns the IP
- A university or other entity owns the IP
- N/A
Please check all of the following that apply to your technology?*
- Patent application submitted
- Patent issued
- We have trade secrets or other intellectual property (IP)
- N/A
What unmet need do you plan to address with your innovation?*
What is unique about your proposed product?*
Who is the intended customer for your product?*
Who are your competitors? Are you aware of competitive technologies?*
Briefly describe your commercialization strategy, e.g., how do you anticipate getting your product to market?*
Briefly describe if you own, license or are on a path to controlling your intellectual property.*
Previous SBIR experience
Has your company ever applied for SBIR/STTR before?*
- Yes
- No
Has your company 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 SBIR/STTR training before?*
- Yes
- No
If yes, please provide the date(s) and topic(s):
Have you identified an Agency and solicitation? What is the submission deadline?*
Is there anything else you would like to add?
Please attest that above information supplied is true and accurate by adding your name and title.*
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Questions on how to apply?

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CT Next Assessment Form

In the past 12 months...

Federal Eligibility Requirements

Tell us about your SBIR/STTR Project

Previous SBIR experience

Questions on how to apply?