Please answer the following questions. Your answers will be reviewed by the Innovations Platform Advisory Committee (IPAC) to determine what category your company falls under and what benefits you are eligible to receive. Please self-identify what category you think you fall under. * - Select -Pre-Revenue Start-Up CompanyMature Company First Name * Last Name * Your Title (credentials) Your Company Name * Company: Phone * Email * What is your vision for your company? How will your innovation result in a substantial and measurable impact on providers, practitioner and/or patients in a PA/LTC setting? * When was your company established? * How many employees do you have? * Who runs the day-to-day business? * How many clients do you have? * PRODUCT: Do you have a product developed? * YES NO Have you tested your product? * YES NO Have you made modifications based on that testing? * YES NO Do you currently hold any patents? * YES NO Who have you received business or product advice from? * Please summarize your business plan. * Growth: Have you identified barriers that could inhibit your growth? * How have you addressed them? * Do you have investors? * YES NO If "YES", How much funding have you raised? * What’s your annual growth percentage for the last 12 months? * If you are expanding into other territories, where are they? * If you are creating other products, what are they? Submit
