Unitus StartHealth Program Application
Business Name
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Business Website
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First Name
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Last Name
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Your Role/Title
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Email Address
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Healthcare Technology Innovation
Please select the items(s) that your business includes:
Required
Primary type of business
Low-income Impact Potential
Estimated number of low-income families who could benefit from your business within 5 years
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Three line description of your business
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Headquarters Country
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Headquarters City
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Year of Incorporation
eg: 1997
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Business Stage
Founder #1: Education/Business Affiliations
Where did you study? Also list any organizations that you've worked with.
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Founder #2: Education/Business Affiliations
For 2nd founder, where did you study? Also list any organizations that you've worked with.
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Do you have a MD advisor who is a reference on your product?
If so, please list their name and affiliation.
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Capital Already Raised (in US$)
How much you have raised from friends, family, prizes, investors, etc.
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Current Fundraising Goal (in US$)
If you are not sure, you can enter zero.
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How did you find us?
Additional Comments
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