PPA Application Step 1 of 11 9% Instructions Click here for application tips for funding success from the Innovation Partnership Investment Committee.Sample Application A sample application should have been provided to you in the same email in which you received your original PPA template. If you have not received a copy of our sample application, please review it again here.Navigating Through This Application This application form consists of multiple pages. You can navigate between them using the Next and Previous buttons at the bottom of each page. You may save your application at any point by clicking save. You will be given a link to return to your application form. Do not lose this link; it is essentially your password. You have 30 days to return after saving your progress. All questions marked with a "*" are required for completion. I have reviewed the "Application Tips for Funding Success" with my sponsor. (See "Instructions" section above)* Yes No Applicant Type*Please ChooseAcademic InstitutionC-CorpLLCPartnershipS-CorpSole ProprietorshipTrustOtherIf "Other," please describe:Which assistance program are you applying for?*Please ChooseFederal Marketing AssistanceMicrovoucher ReviewMicrogrant ReviewTechnical Review Only Contact Information All questions with a "*" are required for completion.Formal name of the organization or company submitting the federal proposal*Fed Tax ID # (FEIN) 8 digit format (##-######)*Organization Website (URL), if applicablePrimary Contact First Name*Primary Contact Last Name*Title*Phone*Alternate PhoneEmail* Address*City*State*Please ChooseAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZIP Code (00000-0000)*Look up your full ZIP Code here.Please indicate if the applicant is: Woman-Owned Minority-Owned Veteran-Owned N/A Minority Status (if applicable)Please ChooseAsian or other Pacific IslanderBlack or African AmericanCaucasianHispanic or LatinoMulti-Racial (not Hispanic/Latino)OtherIf "Other," please describe Company Info Please provide a brief bio of your company. This should be a "one-minute commercial" for your organization, and should include basic information about what you do and define your target markets. Please comment on how the work proposed in this application fits your overall corporate development strategy. It may be appropriate to reference your company's stage of development. Sample Ben Franklin Technology Partners (BFTP), established in 1982, by Governor Dick Thornburg and the Pennsylvania Legislature, is one of the most highly regarded and longest-running programs in the nation, dedicated to growing the state’s technology-based economy. Its longevity is due to its consistency and positive impacts BFTP is looked upon to be the gold standard for technology-based economic development in the country. It is a national and international model, honored with numerous award and commendations. BFTP provides the funding and business expertise that helps the Commonwealth’s technology companies prosper. We serve as a catalyst for economic growth by providing access to capital, business expertise, and a network of resources that fosters innovation, growth, and success. For over 35 years, BFTP has continually evolved its programs and services to respond to economic and market changes. All questions with a "*" are required for completion.Company Bio*Primary (six digit) NAICS Code*Click here to find your NAICS Code. (This is a self-selected code for describing your primary business activities)Please identify your firm's main business activity*Please ChooseAGR - Agriculture/Food ProcessingAUT - Factory AutomationBIO - Biotech/Life SciencesCHE - ChemicalsCOM - Computer HardwareDEF - DefenseEDU - EducationENR - EnergyENV - EnvironmentMAN - Manufacturing EquipmentMAT - Advanced MaterialsMED - MedicalNAN - NanotechnologyPHA - PharmaceuticalsPHO - Photonics/OpticsSOF - Computer SoftwareTAM - Testing/MeasurementTEL - Telecommunications/InternetTRN - TransporationOtherIf "Other," please specifyPlease identify your firm's secondary business activityPlease ChooseAGR - Agriculture/Food ProcessingAUT - Factory AutomationBIO - Biotech/Life SciencesCHE - ChemicalsCOM - Computer HardwareDEF - DefenseEDU - EducationENR - EnergyENV - EnvironmentMAN - Manufacturing EquipmentMAT - Advanced MaterialsMED - MedicalNAN - NanotechnologyPHA - PharmaceuticalsPHO - Photonics/OpticsSOF - Computer SoftwareTAM - Testing/MeasurementTEL - Telecommunications/InternetTRN - TransporationOtherHow many patents have been issued to your company? (Please type 0 if no patents)*How many (if any) patents do you expect to be issued between now and the next 3 years? (Please type 0 if none)*Full-time employees based in Pennsylvania (Please type 0 if none)*Part-time employees based in Pennsylvania (Please type 0 if none)*Full-time employees worldwide (Please type 0 if none)*Part-time employees worldwide (Please type 0 if none)*Full-time PA-based manufacturing or development subcontractors (Please type 0 if none)*Part-time PA-based manufacturing or development subcontractors (Please type 0 if none)*Please select a year and provide your company's revenue for the last 3 years (excluding grants & loans).Current Year2016201720182019202020212022202320242025Current Year RevenueLast Year2016201720182019202020212022202320242025Last Year Revenue2 Years Ago20162017201820192020202120222023202420252 Years Ago Revenue Location All questions with a "*" are required for completion.County*Please ChooseAdamsAlleghenyArmstrongBeaverBedfordBerksBlairBradfordBucksButlerCambriaCameronCarbonCentreChesterClarionClearfieldClintonColumbiaCrawfordCumberlandDauphinDelawareElkErieFayetteForestFranklinFultonGreeneHuntingdonIndianaJeffersonJuniataLackawannaLancasterLawrenceLebanonLehighLuzerneLycomingMcKeanMercerMifflinMonroeMontgomeryMontourNorthamptonNorthumberlandPerryPhiladelphiaPikePotterSchuylkillSnyderSomersetSullivanSusquehannaTiogaUnionVenangoWarrenWashingtonWayneWestmorelandWyomingYorkCongressional District Number*Click here to find your Congressional District Number.PA State House of Representatives District Number*Click here to find your State House of Representatives District Number.PA State Senate District Number*Click here to find your State House of Representatives District Number. Referred By All questions with a "*" are required for completion.What organization invited you into the Innovation Partnership MicroGrant Program?*Please ChooseBen Franklin TP of Central & No. PABen Franklin TP of Northeastern PABen Franklin TP of Southeastern PACatalyst ConnectionDelaware Valley IRC (DVIRC)Innovation Works (BFTP of Southwestern PA)Life Sciences Greenhouse of Central PAManufacturers Resource Center (MRC)Manufacturing Technology IRC (MANTEC)Northeastern PA IRC (NEPIRC)Northwest PA IRC (NWPIRC)PA BioTechPenn State UniversityPENNTAPPittsburgh Life Science GreenhouseSBDC Bucknell UniversitySBDC Clarion UniversitySBDC Duquesne UniversitySBDC Gannon UniversitySBDC Kutztown UniversitySBDC Lehigh UniversitySBDC Lock Haven UniversitySBDC Penn State UniversitySBDC Saint Francis UniversitySBDC Saint Vincent UniversitySBDC Temple UniversitySBDC University of PittsburghSBDC University of ScrantonSBDC Wharton SchoolSBDC Wilkes UniversityThe Industrial Modernization Center (IMC)University City Science CenterUniversity of PennsylvaniaUniversity of Pittsburgh OEDOtherIf "Other," please describe Previous Federal Grant Experience All questions with a "*" are required for completion. Have you or your organization applied for federal grants in the past? If so, please describe: Approximate number of proposalsWhat type were the majority of your previous awards?Please ChooseSBIRSTTRATPBAAGovernment ContractResearch GrantsPlease identify the Federal agencies where you have submitted applications (check all that apply): Dept. of Commerce DOD Dept. of Education Dept. of Energy DHS DOT EPA NASA NIH NSF USDA First year a proposal was submitted: (format yyyy)Last year a proposal was submitted: (format yyyy)Have you or your organization previously received federal grant funding? If so, please describe:Approximate no. of awards received by the company currently making application:Approximate no. of awards received by you under other companies:What type were the majority of previous awards received by the company currently applying:Please ChooseSBIRSTTRATPBAAGovernment ContractApproximate total dollar amount of awards to this company:First year an award received by this company: (format yyyy)Last year an award received by this company: (format yyyy)In its published solicitation, each federal agency lists the various research topics for which projects will be selected. In order to receive funding, you must show that your proposal is a good match with one of these topics. Please type below an exact copy of one or two paragraphs directly from the solicitation that you think best shows this match.Paragraphs from solicitation:*Briefly describe your communication to date with the Federal Agency's Program Manager. Please provide a date or timeframe when you spoke with the PM; PM's name; and specific comments made by the PM regarding your proposal plans/technology or any advice they might have provided.Program manager description:* Federal Agency All questions with a "*" are required for completion.To what Federal Agency are you intending to submit your proposal?*Please ChooseDept. of CommerceDODDept. of EducationDept. of EnergyDHS/HSARPADOTEPANASANIH (DHHS/NIH)NSFUSDAPlease provide the hyperlink to the solicitation to which you are submitting a proposal:*If available, please copy the URL of the web page containing the research topic description in the solicitation or program announcement. (Note: If the research topics have not yet been announced, please state this or simply leave this section blank.)What type of proposal are you planning to submit?*Please ChooseSBIR Phase ISBIR Phase IISTTR Phase ISTTR Phase IIATPBAAFastTrackDirect to Phase IIOtherWhat is the federal proposal submission deadline?* Estimated federal grants dollars being requested:*If the funding you have requested exceeds the standard limits, have you cleared this with the agency program manager?*Please ChooseYesNoIPART Grant Program DescriptionTo which DOD branch are you applying?*Please ChooseAir ForceArmyDARPAMDANavyIf applying to the NIH, please indicate which Institute:*Please ChooseNCI (National Cancer Institute)NEI (National Eye Institute)NHLBI (National Heart, Lung, and Blood Institute)NIA (National Institute on Aging)NIAAA (National Institute on Alcohol Abuse and Alcoholism)NIAID (National Institute of Allergy and Infectious Diseases)NIAMS (National Institute of Arthritis and Musculoskeletal and Skin Diseases)NIBIB (National Institute of Biomedical Imaging and Bioengineering)NICHD (National Institute of Child Health and Human Development)NIDCD (National Institute on Deafness and Other Communication Disorders)NIDCR (National Institute of Dental and Craniofacial Research)NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases)NIDA (National Institute on Drug Abuse)NIEHS (National Institute of Environmental Health Sciences)NIGMS (National Institute of General Medical Sciences)NIMH">NIMH (National Institute of Mental Health)NINDS (National Institute of Neurological Disorders and Stroke)NINR (National Institute of Nursing Research)NLM (National Library of Medicine)(Describe if other)Solicitation Number, if available Proposal Description Please pay careful attention to your word count for each section. Narrative sections that do not conform to the character length specifications will be truncated to meet this standard noted for that section. All questions with a "*" are required for completion. Please provide a brief title for your proposal. See the sample below and highlight to type in YOUR PROJECT TITLE.Proposal title:*Please provide a brief (no more than 3 sentences) project summary. See the sample below and highlight to type in YOUR PROJECT SUMMARY. NOTE: This summary will be used to arrange for technical reviewers and should be descriptive enough to provide a sense of the subject matter and skills appropriate to review. It should not contain proprietary or confidential information.Project summary:*Company Name X creates and tests widgets and applies electronic nodes to record all functions. Our current technology captures electrical impulses at a specific node, when touched and provides electric shock feedback to the person touching the node, depending upon the amount of pressure exerted by the touch/grip. Our focus for this proposed project is to analyze and translate all meaningful data from this node and apply it to appropriate use of holding the widget so as to prevent injuries received from misuse and improper grip.Please describe your proposed project in the next few paragraphs and how your proposal addresses the solicitation topic or identified federal interest. 1. What work do you intend to complete in your project, and how does this work address the solicitation topic or identified federal interest? 2. Highlight the overall benefits your technology offers over competing technologies and the reasons why the federal agency should select yours for an award. Provide a succinct description of other competing technical approaches. (Example: a laser data transmitter vs. a wire connected data transmitter) How does your approach best address the solicitation? (Example: a laser can provide a direct connect anywhere within a line of sight without pre-wiring the facility or area). 3. If matching funds are required, briefly indicate the source and type of these contributions. (limited to 12,000 characters)Proposal Description*This field is only used to provide images that can not be included in the online application description.FileAccepted file types: jpg, gif, png, pdf, Max. file size: 2 MB. Commercialization Briefly describe one or more potential commercial applicants that will become possible as a result of your project. Limited to 3,500 characters including spaces.All questions with a "*" are required for completion.Potential commercial applications:*Please answer the following questions: 1. How will your proposal lead to bringing your application of technology to this market? 2. How will you actually bring the project to the market (manufacture, license, contract, manufacturer, etc.)? 3. Do you have any expression of interest from another organization? Limited to 3,500 characters including spaces.Bringing the project to market:*Economic Impact In the next 5 years, what do you forecast will be the economic impact of your project on our region? In the nation? Globally? Express results in terms of estimated numbers of new jobs, additional revenue, etc. Limited to 1,000 characters including spaces.Estimated economic impact:* Project Team Please identify what skills are necessary to accomplish the work described in this application. Identify which members of the project team will provide the skills, and identify the skills that will need to be acquired/hired. Limited to 3,500 characters including spaces.Project team and skills:*Who will be the Principal Investigator (PI) or Project Leader?*What will his/her employment status be with respect to this project, if a federal grant is awarded?*Please identify and provide a brief summary of the qualifications and time allocation for this project of the Principal Investigator (or Project Leader) and other key members of the project team. Also, provide an estimate in percent, of the amount of work that will be done by the company.Qualifications and time allocation:* Budget for MicroGrant/MicroVoucherPreviously in the PPA, you indicated whether or not you were interested in having your Pre-Proposal considered to receive a: Technical Review Only, MicroGrant (MG), MicroVoucher (MV), or Federal Marketing Assistance (FMA) award. If you wish to be considered to receive an MG, MV, or FMA – please read the guidelines for each program and view each sample before completing your PPA budget and uploading it to this page.MG Budget Sample & MV Budget SampleBLANK PPA BUDGET FOR COMPLETIONPlease upload your completed PPA budget here:*Max. file size: 2 MB.
