Surgical Innovation Group Contact Request Intake Form

Surgical Innovation Group Contact Request Intake Form

First Name

Last Name

Email Address

Phone Number

Primary Penn State campus affiliation

Department

Position Classification

FacultyNurseClinicianStaffStudentMedical resident or fellowPostdoctoral researcherOther

Other classification:

Idea / Project Information

Please provide a brief description of your technology, idea or clinical challenge.

Have you disclosed your idea to the Office of Technology Management or Center for Medical Innovation?

Current stage of development

Idea generationDesignPrototype developmentSeeking capital investmentOther

Other stage of development:

What services do you think your project may require, or are you interested in learning more about?

Intellectual Property (IP) protectionHelp connecting with collaboratorsSeeking entrepreneurial advisor/mentorProject management assistancePrototyping or 3D printing servicesFunding opportunitiesMarketing, graphics, illustrations or other various visualizationsRegulatory guidanceMarket analysis or business strategyOther

Other services required:

Help connecting with collaborators:

Clinical facultyEngineering facultyOther

Other collaborators:

Have you done any work to determine the customer or market for your idea?

Do you have any funding available for your project?

Please provide any other relevant information about your idea.

Contact Information