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Ataraxia Engagement Form
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* Indicates required question
Business Name
*
Your answer
Website
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Your answer
Company Twitter URL
Your answer
Company Instagram Account
Your answer
CEO LinkedIn URL
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Your answer
CEO Twitter URL
Your answer
Corporate structure
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LLC, c-corp, S-corp, B-corp, other, subsidiary?
Your answer
Where is the company legally incorporated?
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Your answer
Physical company location (HQ):
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Your answer
Brief company description (50 words)
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Your answer
Date Founded
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MM
/
DD
/
YYYY
Stage of Company
Pre-revenue
Revenue
Prototype
Market
Pre-Clinical
Clinical
Beta
Moment-of-Inception
Spinning Out
Stealth
Academic
Other:
Problem being solved (100 words)
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Your answer
Solution (100 words)
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Your answer
Competition/differentiation (100 words)
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Your answer
Status of IP
Issued
Filed
Provisional
Licensed
US
Worldwide
Trade Secrets
University Owned
TechTransfer Office Involved
Is the core IP within the company?
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Yes
No
How much are you raising this round?
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Your answer
Terms of current round?
Your answer
Current Valuation
*
Your answer
Have you lined up or committed a lead investor? If yes, who?
Your answer
What milestone(s) will be achieved with the current funding round?
Your answer
Number of full-time team members?
Your answer
Number of part-time team members?
Your answer
CEO + C-level backgrounds (50 words each + LinkedIn link)
Your answer
Current revenue (YoY, MoM)?
Your answer
EBITDA?
Your answer
Anything else important you think we should know (50 words).
Your answer
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