Local Business Program – LaunchPad PEI Application Form

Startup Team
If a solid team is in place, please tell us how you have solidified your roles. Elaborate below if you wish.

Corporate Board
If you have a corporate board in place, please ensure that you have provided the proper titles with their names below.

Existing Company Creating New Technology Through A Division
Please elaborate below.

• • Please elaborate based on the selection above. *

    (Max 250 words)

    (Max 4000 characters)

  • Please describe the make-up and dynamics of your team *

    (Max 250 words)

    (Max 4000 characters)

  • What are the key areas you want to strengthen as a company within LaunchPad PEI? *

    (Max 250 words)

    (Max 4000 characters)

  • Upon graduation, would you be willing to relocate permanently? Please Describe. *

    (Max 250 words)

    (Max 4000 characters)
• Company Information

  • Company Name *
    Please only enter the full legal company or business name here. If you do not have a name or have not registered the business, please enter “TBD”.

  • Company Website (if available)

  • Country *

    Select CountryCanadaUnited StatesUnited KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia And HerzegowinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D’IvoireCroatia (Local Name: Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard And Mc Donald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People’s Republic OfKorea, Republic OfKuwaitKyrgyzstanLao People’s Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedonia, Former Yugoslav Republic OfMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts And NevisSaint LuciaSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia, South Sandwich IslandsSpainSri LankaSt. HelenaSt. Pierre And MiquelonSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis And Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabwe

    Address *

    City *

    State/Province *

    Postal / Zip Code *
    If you have no corporate offices, please enter your personal address here.
• • Is your company currently incorporated? *

    Yes, this company is incorporated

    No, this company is not incorporated, but we plan to incorporate within the next 3 months

    No, this business is not incorporated and we do not have plans to incorporated

     

    Please select the best answer here.

  • If your company is incorporated, please list the country or countries you are legally incorporated in:

    (Max 100 words)

    (Max 4000 characters)
• • What type of business are you running (sector)? *

    – Select an option -Information and Communications TechnologyBioscience / Bio-TechAdvanced ManufacturingAerospace and DefenseFinancial ServicesRenewable Energy / Clean TechOther

    Please select the best answer here.

  • If “Other” selected above, please specify.
• • Have you received funding to the date of this application? *

    Self-Funded

    Friends & Family

    Private Investment (Please Elaborate Below)

    Seed Capital (List Investors Below)

    Series A (List Investors Below)

    No Funding to Date

     

    Please select all that apply.

  • Please describe this funding and list any private investors (if applicable)

    (Max 250 words)

    (Max 4000 characters)

  • How much funding total has your company raised to the date of this application? *
    Please convert this funding into Canadian Dollars and only enter a number in this field (No letters or symbols).
• • Describe the Product/Service *

    (Max 250 words)

    (Max 4000 characters)

  • Please provide a link to your Product or Prototype Demo. *
    If you do not have a demo of your product ready, please enter “N/A”.

  • Please include required instructions for this linked demo (if applicable)

    (Max 100 words)

    (Max 4000 characters)
• • Technology Development Phase: *

    Alpha or Prototype

    Beta

    1.0

    2.0

    Not Applicable

     

    Please select the best answer here.

  • Please elaborate on the phase of development of your technology. *

    (Max 250 words)

    (Max 4000 characters)
• • Describe competition and advantages of your product or service. *

    (Max 250 words)

    (Max 4000 characters)
• Business Profile & Details

  • Revenue Model *

    (Max 250 words)

    (Max 4000 characters)
• • Market *

    (Max 250 words)

    (Max 4000 characters)
• • What is your product’s unique market offering? *

    (Max 250 words)

    (Max 4000 characters)
• • Intellectual Property Involved in your Technology *

    (Max 250 words)

    (Max 4000 characters)

  • Do you fully own this technology and this Intellectual Property? *

    Yes, the company fully owns all technology and IP

    No, the company does not fully own all technology and IP

     
• • Evidence of market interest and uptake *

    (Max 250 words)

    (Max 4000 characters)
• • What level of future funding are you prepared for? *

    Seed Capital

    Series A

    Higher Levels of Funding

    None of the Above

     

  • Please describe how these funds will be utilized and any applicable deadline for receipt of funding. *

    (Max 500 words)

    (Max 4000 characters)
• • Please include at least one (1) of the following three (3) items:

  • Link to Company Video
  • Pitch Deck Upload
    This should be in a standard file format (E.g. MS PowerPoint or PDF).
  • Company One-Pager or Executive Summary Upload
    This should be in a standard file format (E.g. MS Word or PDF).
  • Please attach your most recent financial statements. *
    This must be in a standard file format (E.g. MS Excel or PDF).
  • No