Project Name:
     

Brief Technology Description:
     

Technology Area (select one):
    Energy

    Life Science - complete the following items:
          Indicate specific Life Science area:
                Select one... Agricultural biotechnology Biomaterials Diagnostics Drug delivery Drug development Healthcare IT Health-related homeland security and biodefense Life Science IT Medical devices Nanotechnology convergence Research and discovery tools Space-related biomedical and genomics research Telemedicine Therapeutics Vaccines Other
               (for more information on these areas, click here)

    Other emerging Technology (IT, aerospace, nanotechnology, advanced
          materials, ...

Award Request Type (select one):
    Pre-Seed Commercialization Award ($250K or less)


    Commercialization Award (typically $500K to $2.5M)

     Indicate how much prior equity has been raised (pre-seed applicants
     can have no more than $500K of prior equity raised):
               

Award Request Amount:
     

Company Name:
     

Contact's First Name:
     

Contact's Last Name:
     

Contact's Job Title:
     

Contact's Direct Phone #:
     

Contact's Mobile Phone #:
    

Contact's e-mail Address:
     

County (location of primary presence within the Gulf Coast region):
     Select one... Angelina Austin Brazoria Brazos Burleson Chambers Colorado Fort Bend Galveston Grimes Hardin Harris Houston Jasper Jefferson Leon Liberty Madison Matagorda Montgomery Nacogdoches Newton Orange Polk Robertson San Jacinto Trinity Tyler Walker Waller Washington Wharton Other

Permission to receive e-mail from the Houston Technology Center:
      I grant permission to be placed on the HTC e-mail distribution list

Company Type (choose one):
      We are a private company.
               Enter current company structure (C-Corp, S-Corp, LLC, ...)
              
               If not a C-Corp, must be willing to commit to conversion to C-Corp
               before the application will be submitted to the State.  The
               restructuring can be deferred until after the RCIC Board meeting,
               before the State application deadline (typically 2 to 3 weeks).

      We are a public company.
               Please explain why you cannot raise other funds for this project:
              

To be eligible for an Award, you must meet all of the following criteria:

  We are commercializing Emerging Technology.
            Enter industry:
              Select one... Aerospace Biotechnology Computer and software technology Defense Energy Information Manufactured energy systems Micro-electromechanical systems Nanotechnology Semiconductors Medicine Life sciences Petroleum refining and chemical processes Other area

  We are partnering or will partner with a Texas public or private university.
            Indicate university and relationship, and how this relationship
            will impact the commercialization of this technology:
             

  We have a defined project scope, commercialization path & business plan.

  This project will have a demonstrable economic impact in Texas.
            This includes a guarantee of commercialization or manufacturing in
            Texas.  The economic impact could be the creation of high-paying
            jobs in Texas, economic benefits to other partners located in Texas, or
            increasing the State's national or global competitiveness in key
            emerging technology industries.

  This project has recently raised or will commit to raise matching funds from
       other sources.  The matching funds should be at least as large as the
       requested amount. 

  The company has clear ownership of the technology's IP.
            Typical industry accepted practices can be used to protect the
            technology (trade secret, copyright protection, employee agreements,
            time-to-market, ...)
            Please briefly summarize how the company's IP is protected:
                  

  This project may result in a scientific or medical breakthrough, or a
            breakthrough in clean energy technologies.  Your technology may be
            considered a breakthough if your technology solves a new problem and
            is a significant improvement over current technologies.  Explain why you
            have breakthrough technology:
                  

  We have documentation of independent validation of the specific technology
            that will be the basis of the application.  Validation can be from
            successful prototype or pre-production testing of the technology by
            potential customers.  Please briefly summarize how the technology has
            been validated:
                   

  If funded, we accept an equity investment by the State AND (for Pre-Seed
            applicants only) we would be willing to accept up to the first $500K from
            the State as convertible debt.