Please complete this form as accurately as possible, so we can better assess your company, the solution provided, where you are relative to the growth or maturity of the business and if a solid fit, how we might better tailor the program to meet your needs.

AgLaunch365 will operate in three phases, allowing startups to participate in the phases that are relevant to each company's stage of growth. Program deadlines are:

1. Phase I: Business model development/"customer discovery" due by 8 a.m. CT on Monday, August 13, 2018.
2. Phase II: Refine product/"getting field-ready" due by 8 a.m. CT on Monday, October 15, 2018.
3. Phase III: Access to network of innovative farmers/"field trials" due by 8 a.m. CT on Monday, January 7, 2019.


For more information about AgLaunch365 visit http://aglaunch.com/what-we-do/.

Company name *
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Your name *
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Email address *
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Company website *
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Phone number *
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Mailing address *
Your answer
Your position with the company *
Team size (number of people on the team or employed by the business) *
Your answer
Board/Advisory board (please list names and affiliations)
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Provide one reference with name, affiliation, email, and phone number. *
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How large is the addressable market? (Be specific in your answer and tell us how you calculated this number.) *
Your answer
Please indicate which of the following categories your innovation fits best: *
What stage is your company in? *
What year did you start your company? *
Your answer
What is the legal structure of your company? *
What patents or licenses do you currently have? *
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How much capital has your company raised to date? *
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Which accelerator, incubator or other business support programs have you participated in previously? List specific programs and dates of participation.
Your answer
Describe how you have worked with farmers to develop your technology.
Your answer
Is your company located in a USDA rural area? If you don’t know you can check at this link: https://eligibility.sc.egov.usda.gov/eligibility/welcomeAction.do?pageAction=rbs *
Copy and paste your One-Page Executive Summary. Tell us more about your company in roughly one page. Be sure to include problem, solution, market, competition, and metrics. *
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What aspects of AgLaunch365 are you most interested in? *
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What do you hope to get out of your experience with AgLaunch365? *
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How did you hear about AgLaunch and AgLaunch365? *
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Is there anything else we should know?
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