I-Corps@NCATS Program Application Form
Select desired I-Corps cohort:
Winter 2023: January 27 to March 10
Type of Applicant
I have an idea/innovation and/or team
I am looking to join an existing team
Applicant Information
College Affiliation
First Name
Last Name
Academic Rank/Degree
Department/Office
Phone
Email
Describe yourself and your interest in technology commercialization.
Idea/Innovation
Please complete one form per team. Team lead should complete the application on behalf of the entire team. Use "Add another team member" to complete information for each person.
College Affiliation
Do you need assistance recruiting team members?
Yes
No
Team name
Team Member Information
First Name
Last Name
Academic Rank/Degree
Department/Office
Administrative Contact
Phone
Email
Team Role
Academic lead
Entrepreneurial lead
Mentor
How did you first learn about the I-Corps@NCATS program?
General email announcements
Direct outreach by program (e.g., local program director)
Recommendation of former participant
Other
Other: Please specify
Have you participated in an I-Corps program in the past?
Yes, completed a local program (e.g., offered by the CTSA)
Yes, observed/participated in some of a local training but did not complete
No
Other
Yes: Please provide the year
Other: Please explain
Idea Information
Area of Technology
Diagnostic
Drug/biologic
Education/training
Medical device
Research services
Software/Health IT
Other
Other area of technology: Please specify
Stage of Development (select all that apply to the focus of your current efforts)
Idea generation
Design
Prototype development
Seeking capital investment
Production/sales
Other
Other stage of development: Please specify
Level of Entrepreneurial Experience
Some Entrepreneurial Training
Experience with Start-Up Companies
Experienced Entrepreneur
Start-Up Founder
Other
Provide a brief description of the technology or idea in which you are interested.
DO NOT disclose any confidential information.
Please describe the customer or market for your technology or solution and what work you have done to validate this market (if any).
Please indicate your technology/innovation IP ownership.
University-owned IP
Student-owned IP
External IP
Unknown
None
Which of the following statements is most reflective of your project's commercialization readiness at this time?
Our project is ready for commercialization
Our project is not yet ready for commercialization
We aren't yet sure that our project is commercializable
Have you considered forming a company to commercialize your product?
Yes
No
There is already a company.
Have you considered an SBIR/STTR for this project?
I already have an SBIR/STTR award for this project.
I submitted but did not get funded.
I submitted but do not yet know the outcome of the submission.
I plan to submit in the future.
I do not have an SBIR/STTR award and do not plan to apply at this time.
N/A – I did not know these programs existed.
What do you expect to gain from this program?
You will be contacted following your registration to discuss course details. In the meantime, please contact
cmi@pennstatehealth.psu.edu
with any questions.
By selecting this box, you agree to:
Attend and participate in all I-Corps@NCATS program live course sessions.
Attend office hour sessions with instructors biweekly.
Conduct 30 customer discovery interviews during the 5-week course.
I acknowledge that I will participate in all of the above