Application Form

INSIGHT ACCELERATOR LABS accelerating healthcare innovation

Application Form

Insight Accelerator Labs would like to gain a better understanding and general background of your startup. Please fill out the application form below. Once your information has been submitted, IAL will follow up for more details, as well as provide a formal NDA as the process progresses.

Company Name*
Company Location*
Street Address Address Line 2 City State ZIP Code
Phone
Website
Technology
What is your core technology or Intellectual Property? What is your device and what will it do? How close are you to that goal?
Market Opportunity
Describe the user need, the market opportunity and the competitive landscape your core technology.
Founder Details*
Please tell us about each founder and their role. Explain how you met and how long you’ve been working together.
Founder One
Full Name*
First Last
Title/Role*
Email*
Founder Two
Full Name
First Last
Title/Role
Email
Founder Three
Full Name
First Last
Title/Role
Email
Personal Dedication Plan*
Are each of the founders committed to working full time, on site for the startup or will some be part time. Please indicate for each of the founders listed in section 2.
Company Details*
How many full time employees do you have? How many part time employees? Tell us about specific experiences, expertise and educational backgrounds of your team.
Funding*
Please provide a history of funding sources and events as well as anticipated future funding targets.
Name
This field is for validation purposes and should be left unchanged.

Founder One

Founder Two

Founder Three

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