Startup Supporter Intake Form (V2)

Startup Supporter Intake Form

Join the network to work with our companies! LifeX facilitates opportunities for individual contributors and service providers to work directly with promising life science and healthcare startups. While we do not function as a recruiter or job board, we maintain a database of information that is shared with our broader startup ecosystem in order to facilitate connections as needs arise either through LifeX programing or individual startups.
General Information:
Name*

First NameLast Name
Permanent E-mail*
An email we can always reach you at that you check regularly (i.e. ideally not associated with a temporary employer or university)
Current Job Title
Note: If you are a current student, list your title as 'Student'.
Current Employer
Note: If you are a current student, list your employer as the university you attend.
LinkedIn/Website
LifeX aims to connect HealthTech startups with two subgroups of people:

1. Service providers include vendors or organizations that provide professional services to startups as part of their typical client/customer pool
- Examples: Lawyers, accountants, regulatory consultants, etc.
- If you opt in as a service provider, we assume you are not looking to engage as an employee, company leader, or mentor/advisor for a startup
2. Individual contributors include people who are interested in contributing their personal efforts within the context of a startup, often in an ad hoc or ambiguous capacity. This includes people looking to:
- Serve as a leadership role in a startup (includes entreprenerual leads)
- Work as an employee/intern at a startup
- Act as a mentor or advisor for a startup
- Work as an intern at LifeX supporting startups through commercialization projects (includes accelerator internship)
Are you filling out this form as a service provider or individual contributor?*

I am a service providerI am an individual contributor
At a high level, why are you looking to engage with LifeX?
How did you find out about us? Please feel free to name anyone who referred you.

Individual Contributor Questions
The following questions serve to gather more information about the capacity with which you are looking to engage with startups. This helps our team best understand how and where you might be able to plug into the LifeX ecosystem.

LifeX has the capacity to engage three subtypes of individuals:

1. Intern/Employee Talent
- Typically (but not limited to) students or early career individuals
- These individuals want to work directly with/in a startup to apply their skillset to forward the company
2. Startup Leadership Talent
- Individuals looking for a leadership role in a startup in an executive/operational capacity
- Many projects/startups in our network have academic or clinical founders who need a hands on operator, or entrepreneurial lead, to forward commercialization efforts
3. Expert Guidance
- Individuals who want to get involved in our ecosystem but aren't looking for a formal role as a startup leader or employee
- This includes people that could act as a mentor, advisor, or board member for startups
- Additionally, these individuals can engage with LifeX in roles such domain experts or guest speakers that participate in LifeX programs and events
As an individual, how do you intend to engage with startups through LifeX? (Check all that apply)*

Working in a startup as an intern/employeeServing in a startup in a leadership capacityProviding expert guidance for startups and/or LifeX
What capacity would you be looking to engage? (Check all that apply)

Full time (40 hours/week)Part time (at least 20 hours/week)Hourly
What are your areas of experience/expertise? (Select all that apply)

Startup Leadership/Expert Intake
What are your particular strengths/experiences that make you well suited for working with early-stage startups? (200 words or less)*

0/200
Have you ever been an operator or early employee in a startup company? *
Why is now a good time for you to pursue an entrepreneurial opportunity (in terms of time commitment, capacity, risk, etc.)? If you are working full-time, is your availability during working hours flexible or limited? (200 words or less)*

0/200
Are you applying to participate as an Entrepreneurial Lead through our Connect program?

YesNo
LifeX Connect is an opportunity for life science and HealthTech startups who are considering participating in LifeX programming to connect with potential Entrepreneurial Leads.

One of the largest barriers for academic spinouts is not having an operational business lead focused on commercial validation and progress outside the lab. The LifeX Connect process is a way for you to evaluate mutual fit with the startups seeking fractional leadership.

After filling out this form, if a potential fit is identified, the LifeX team will reach out to explain next steps in the process.
Is there a particular Connect company you are most interested in? Please list all that apply here.
Are you interested in joining a startup in a long term, operational leadership role beyond this initial fractional engagement? What evidence would you need to feel comfortable making this jump?
What specific experience do you have that would be directly applicable to your preferred company/companies?
(Optional) Please attach a resume, CV, or other supportive information you feel would like to include in your application

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Submit the form using the button below. Thank you!
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Startup Supporter Intake Form

General Information:

LifeX aims to connect HealthTech startups with two subgroups of people:

Service Provider Questions

Individual Contributor Questions

LifeX has the capacity to engage three subtypes of individuals:

1. Intern/Employee Talent

2. Startup Leadership Talent

3. Expert Guidance

Intern/Employee Intake

Opportunity Preferences:

1. Talent Pool (Intern/Employee Database)

2. LifeX Accelerator Internship

Startup Leadership/Expert Intake

Submit the form using the button below. Thank you!