LifeX Startup Intake Form

LifeX Startup Intake Form

Please complete this form if you are a startup interested in engaging with LifeX, including applying to the LifeX Accelerator, LifeX Launchpad, LifeX Ventures, LifeX Connect, or participating in the LifeX community via events and other opportunities.
Company Information
Company Name*
Brief Company Description*

0/50
Industry Vertical*
ctrl+ select to choose multiple
Company HQ Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Website
Optional
Contact Information
Primary Contact Name*

First NameLast Name
Primary Contact Role*
CEO, Founder, etc.
Primary Contact Email*
example@example.com
Primary Contact Phone
Please enter a valid phone number.
Primary Contact LinkedIn
Optional
What is your primary interest in connecting with LifeX?

I am ready to apply for funding and/or support through a specific LifeX programI am interested in getting involved in the LifeX community and would like to learn more about LifeX programs and opportunitesOther
LifeX Opportunities

LifeX provides programmatic support and services through our LifeX Accelerator and LifeX Launchpad programs, connection to critical talent through the LifeX Connect platform, and pre-seed/seed funding through LifeX Ventures. LifeX also hosts a variets of events and opportunities open to the broader entrepreneurial community.
What LifeX program(s) are you applying for?*

LifeX AcceleratorLifeX Launchpad - targeted expert support and services to address critical needsLifeX Ventures - Early-stage healthcare and life sciences fundingLifeX Connect - access intern talent database or entrepreneurial lead recruitment for filling critical talent needsI don't know - I would like a LifeX team member to provide a recommendation
The LifeX Accelerator is currently accepting applications through January 27, 2025. Virtual accelerator sessions will be held on Tuesdays and Thursdays from 3-5PM and will run from March - June 2025.
LifeX Ventures currently only invests in companies headquartered in the state of Pennsylvania. LifeX Accelerator, LifeX Launchpad, and other supporting services are available to companies located across the country. We consider HQ wherever the company has a physical address and uses for tax filing and business registration purposes.
Additional Company Information
Leadership Team Members & Roles*
Please list and comment on the capacity and commitment of each team member. Are they in an active contributor role or advisory role? Are they currently full-time, or do they intend to join the company full-time in the future?
Is your company incorporated? If so, what type?*
Year Company Incorporated
If applicable
Is the company a university spinout or have other direct ties to a particular university?
If University Association is "other", please specify:
What is the unmet need or problem that you are looking to solve? *

0/200
How does your solution address this unmet need?*

Briefly describe your innovative approach or technology solution to address this problem0/200
Who are your primary competitors? What is your unique competitive advantage?*

0/200
What is your intended business model and who, specifically, is your customer?*

Identify who your paying customer is expected to be, not necessarily the end user0/200
How large is the estimated market size for your solution?*

Please describe your market size in either # of potential paying customers, potential $$ generated by selling your solution to target customers, or both. 0/200
What is the current product development status?*

0/200
What is your IP status? *
List status of options, licenses, and other IP rights grants or owned by the Company.
Have you completed any other business or commercialization programs? (I-Corps, accelerators, etc.) If so, list them here.
Has the business received any funding so far? Please list amounts and sources of dilutive and non-dilutive funding.
Please include how much and from what sources, which may include: pitch competition prizes, non-dilutive funding for commercialization efforts, investment capital, etc.
Do you have any current traction with customers, partners, or collaborators?
Amount Raising*
What are your perceived critical next milestones?*

0/200
What are your goals for engaging with LifeX?*

0/200
Supplemental Documents / Attachments

To supplement your application, feel free to upload an executive summary, presentation/pitch deck, or paper here. You must attach a pitch deck to be considered for LifeX Ventures.
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LifeX Connect Questions

Please fill out this section if you are interested in joining LifeX Connect, a portal for prospective entrepreneurial leads to connect with life science startups.
What type of candidate are you interested in connecting with?

InternEntrepreneurial LeadUnsure
What type of candidate are you interested in connecting with? *
What is the highest priority business need that you hope to address with an Entrepreneurial Lead? *
Demographics-Related Data

Filling out this form and providing demographic information is optional; applicants are not required to provide the requested information but are encouraged to do so. LifeX will not discriminate on the basis of whether an applicant provides this information, or based on any information provided on this form. If you decline to provide this information, it will not adversely affect your application.
For purposes of this form, an applicant is a minority, woman, or veteran-owned or controlled business if the business meets one or more of the following:
- If privately owned, 51 percent or more is owned by minority, woman, or veteran individuals;
- If publicly owned, 51 percent or more of the stock is owned by minority, woman, or veteran individuals;
- In the case of a mutual institution, a majority of the board of directors, account holders, and the community which the institution services is predominantly comprised of minority, woman, or veteran individuals; or
- One or more minority, woman, or veteran individuals have the power to exercise a controlling influence over the business.
Is the business a minority-owned or controlled business?*

YesNoPrefer not to respond
Is the business a women-owned or controlled business?*

YesNoPrefer not to respond
Is the business a veteran-owned or controlled business?*

YesNoPrefer not to respond
Miscellaneous Questions
How did you hear about LifeX?
Please specify:
Should be Empty:

LifeX Startup Intake Form

Company Information

Contact Information

LifeX Opportunities

Additional Company Information

LifeX Connect Questions

Demographics-Related Data

Miscellaneous Questions