SBIR/STTR Match

Name*

First Last

Job Title*

Email*

Legal Company Name*

As filed or planned to be filed with the Indiana Secretary of State’s Office. If your company does not currently have a name, please enter your first and last name.

Office Phone*

Mobile Phone

What type of SBIR/STTR support would you like?*

SBIR/STTR Grant Type*

Applied Research Institute invests in qualified Indiana businesses. Do you currently meet or are you willing to meet these requirements?*

General eligibility requirements: Has 500 or fewer employees Has its headquarters in the State of Indiana or has committed to, or is in the process of, initiating, expanding and/or consolidating operations in the State of Indiana Is primarily focused on the commercialization of research and development, technology transfer, the application of new technology, or is determined by ARI advisors to have significant potential to: Bring substantial capital into Indiana Create jobs or Diversify the business base of Indiana Generate eventual financial returns Has, or will have at least fifty percent (50%) of its employees residing in Indiana, or seventy-five percent (75%) of its assets located in Indiana Has had average annual revenues less than fifty million dollars ($50,000,000) in its two (2) most recent fiscal years and Is not engaged in a business involving real estate, real estate development, insurance, professional services provided by an accountant or a lawyer or a physician, retail sales (except when the primary purpose of the business is the development or support of electronic commerce using the internet), or oil and gas exploration

Yes

Company Information

Address*

Street Address Address Line 2 City State ZIP Code

Please provide a brief summary of your company, product, or idea.*

Company Website*

Company Structure*

Industry*

Date of Incorporation*

Number of current employees*

Is a principal of the company a U.S. military veteran, woman or minority?*

“Principal” is defined as founder or c-suite member with at least a 5% equity interest in the company

Yes

Is the company veteran owned, controlled or led?*

The company has at least 51% veteran in its founding/management team or its current governance board or shareholder base, or the company is led by a veteran CEO. Veteran is a person who served on active duty with the U.S. Army, Air Force, Navy, Marine Corps or Coast Guard, for any length of time and at any place and who was discharged or released under conditions other than dishonorable. Reservists or members of the National Guard called to Federal active duty or disabled from a disease or injury incurred or aggravated in line of duty while in training status also qualify as a veteran.

Yes

Is the company women owned, controlled, or led?*

The company has at least 51% women in its founding/management team or its current governance board or shareholder base, or the company is led by a woman CEO.

Yes

Is the company minority owned, controlled, or led?*

The company has at least 51% minority in its founding/management team or its current governance board or shareholder base, or the company is led by a minority group member CEO. “Minority” is defined based on race, ethnicity, and sexual orientation, including African Americans, American Indians and Alaska Natives, Asians and Pacific Islanders, Hispanics, and LGBTQ individuals.

Yes

Have you received state SBIR/STTR matching funds in the past?*

Yes

If yes, how much previous matching funding have you received?*

How did you hear about us?*

Please specify the referring organization and/or person.

List any Indiana higher-education institutions or other organizations assisting your business.