Maryland Tech Council Mentor Program Application
Date
*
-
Month
-
Day
Year
Company Name
*
Business Category
*
Life Sciences
Technology
Other
Minority Owned Business
*
Yes
No
Minority Owned Business Details
*
Minority
Veteran
Woman
Venture Address (You and or your venture must have a nexus to Maryland)
Street 1
*
Street 2
City
*
County
*
Please Select
Allegany
Anne Arundel
Baltimore
Baltimore City
Calvert
Caroline
Carroll
Cecil
Charles
Dorchester
Frederick
Garrett
Harford
Howard
Kent
Montgomery
Prince George's
Queen Anne's
Somerset
St. Mary's
Talbot
Washington
Wicomico
Worcester
County
*
State
*
Postal Code
*
Venture Executive Leader - First Name
*
Venture Executive Leader - Last Name
*
Please check one of the following groups in which you consider yourself to be a member
*
Please Select
American Indian or Alaska Native
Asian
Black or African American
Hispanic
Latino
Native Hawaiian or Other Pacific Islander
White
Other
Do you work full time on this venture?
*
Yes
No
If no, please provide more information
*
0/100
Email
*
example@example.com
Primary Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Title
*
Referred by
*
What do you do? Please provide a succinct 2-3-sentence description of what you do.
*
Briefly describe the status of the current marketing, funding and staffing.
*
What is the problem? In a few sentences, please describe what problem you are solving.
*
Are you currently generating revenue? If not, How will you make money? In a few sentences, describe who will pay you and how you envision selling to them
*
What is the secret sauce? In a few sentences, please describe what is special about your solution and product.
*
Describe the IP status.
*
What type(s) of assistance are you seeking?
*
Business Development
IP Strategy
Commercial potential of technology
Team Formation
Informal Feedback
Additional Comments
*
List other mentoring services or programs you have received
*
Attach Bio
*
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Submit current Executive Summary or pitch deck
*
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