Accelerator Application - HealthTech 2019

Basic Info

1. First Name *This question is required.

2. Last Name *This question is required.

3. Phone # (including area code) *This question is required.

4. Primary Email *This question is required.

5. Gender *This question is required.

Please enter an 'other' value for this selection.

7. If you live in the 10-county region surrounding Chattanooga, TN, please indicate your resident county below: *This question is required.

8. Are you a veteran? *This question is required.

Company Info

9. Name of Company *This question is required.

10. Year Founded *This question is required.

11. Your Role/Position *This question is required.

12. Number of Employees (including # of full-time, part-time, and contract) *This question is required.

13. Company Address *This question is required.

	Line 1
	Line 2 (Apt., suite, etc.)
	City
	State
	Zipcode

14. Links for Social Media

	Business Website
	Twitter Handle
	Facebook URL
	LinkedIn URL

15. Describe your company. What is the problem you are solving and why is it important? *This question is required.

16.

Describe your business model. How do you make or plan to make money?

*This question is required.

17. What stage of development is your company/product? *This question is required.

Please enter an 'other' value for this selection.

What is the next milestone your company needs to reach? *This question is required.

18. From what sources has your company received funding? Select all that apply. *This question is required.

19. Please provide the names, skills and experience that make up your startup team? (include your own) *This question is required.

20. What are your expectations for this accelerator program? *This question is required.

21. Describe any corporate partnerships you have or are pursuing: *This question is required.

22. What specific goals/connections/customers are you looking to achieve?

23. If you are accepted into the program, will you be in need of housing for the duration of the accelerator?
Some housing may be available. *This question is required.

How did you hear about the CO.LAB Accelerator? *This question is required.

24. Please provide a link to an up-to-date company overview or pitch deck which includes the following:

A short business summary
A description of the problem or opportunity you are addressing in this space (might say “healthcare” or something industry specific)
Explanation of your product or service and expected revenue model
A summary of the competition in this space and go to market strategy
Product and benefits, roadmap
Description of current revenue, or projected revenue model
Any other relevant details that will enable us to assess your company’s fit for this program

Accelerator Application - HealthTech 2019

CO.LAB HealthTech Accelerator // Application