Founder Application

New Application Available!

We have a new and improved application process, please go to www.startuphealth.com/apply-now to submit your founder application.

Founder Application

StartUp Health’s unique platform leverages the power of expert coaching, global community, and media exposure to help ambitious entrepreneurs transform health.
Prior to joining, you will meet with our Admissions team so we can get to know you and the health moonshot you are working to achieve. As a first step, please complete this Founder Application.

Founder Information
First Name*
Last Name*
Company Name*
Title/Role*
Email*
example@example.com
LinkedIn Profile*
Please include a direct link
Founder Bios (backgrounds, roles and full-time/part-time status)*
Founder Introduction Video*
Please create a video to introduce yourself to the StartUp Health team (tell us about your background and why you are passionate about your company's vision)! Enter the URL of a 60-90 second video (unlisted on YouTube, Vimeo, etc.).
Are you willing to provide peer support to other Health Transformers in the StartUp Health community?*

YesNo
Your Moonshot Vision
Company Website*
Please include a direct link
Which primary Health Moonshot are you working to achieve?*
Which secondary Health Moonshot are you working to achieve?
If your company falls within more than one moonshot, select the secondary moonshot here
Which tertiary Health Moonshot are you working to achieve?
If your company falls within more than two moonshots, select the tertiary moonshot here
Tell us about your company's long-term vision and moonshot impact.*
Describe what your company does in 140 characters or less.*

0/140
What are your top three challenges/needs?*
What are your top three strengths/opportunities?*
Company Information
Presentation Link*
Please provide a link (Dropbox, Google Drive, etc.) to your most recent presentation deck.
Company's Primary Location/Headquarters*
City, St and/or Country
Number of Full-Time Team Members*
Working solely, full-time on the company
Team Diversity - please let us know if any of your founders fit in the categories below by checking the applicable boxes*

Female FoundersMD/PhDsBIPOCSerial EntrepreneursLBGTQ+None of abovePrefer not to answerOther
Advisor/Board Member Bios*
Your Product Stage*

ConceptPrototypeBetaMarket
Please provide short overview on your current traction (revenue, user/pilot metrics, product development/validation, etc.)*
Total Capital Raised to Date (type and amount)*
(e.g. $200K F&F or $5M Series A, etc.)
How are you currently funding the business (revenue, grants, founder investment, external investment, etc.) and how many months runway do you have?*
How did you hear about StartUp Health?*

LinkedInTwitterWebsiteNewsletterIndustry EventStartUp Health MagazineMet StartUp Health Team MemberReferralAttended StartUp Health Festival at HLTH/ViVESocial Media
StartUp Health Team Member met or referred by:*

Steven KreinUnity StoakesBari KreinLauren SchaferLogan PlasterJennifer HankinRicco Mendes
Referred By:*
Your Phone Number*

Area CodePhone Number
Your Mailing Address
Street Address*
Street Address Line 2
City*
State
(if a U.S. company)
Postal / Zip Code*
Country*
Founder T-Shirt Size*

SmallMediumLargeX-Large
Should be Empty:

New Application Available!

Founder Application

Founder Information

Your Moonshot Vision

Company Information

Your Mailing Address