SMALL BUSINESS DEVELOPMENT CENTER

Emerging Technologies Fund Application

Company NamePhoneFederal Project Title (from SBIR/STTR Solicitation)Federal Program (SBIR/STTR Phase I or II?)Department Name(Agency name)Topic (if applicable)Topic Number (if applicable)Project Description(1500 words)

Primary Technology Area (select one)

☐ Advanced Automotive, Manufacturing, Materials, Information, and Agricultural Processing

☐ Alternative Energy☐ Homeland Security and Defense☐ Life Sciences

Date of Federal SBIR/STTR submission deadline (MM/DD/YYYY)Anticipated Decision Date (MM/DD/YYYY)Anticipated Funding Date (MM/DD/YYYY)Anticipated SBIR/STTR Project Completion Date (MM/DD/YYYY)Anticipated Award AmountProject Title(Company’s description of Project Title - Short Title)

State Headquarters | Seidman College of Business | Grand Valley State University50 Front Avenue SW, Suite 1020 | Grand Rapids, MI 49504-6424

(616) 331-7480 | www.SBDCMichigan.org

SMALL BUSINESS DEVELOPMENT CENTER

Date ETF Application Was SubmittedCollaboration Partner (if STTR)How many previous SBIR/STTR Phase II Awards has your company received?

I certify that the answers on this application are correct and true to the best of my knowledge. I realize that all information provided by me is important and that the Michigan Economic Development Corporation (MEDC) and the Michigan Small Business Development Center (SBDC) will rely on such information in making and distributing an award under the MEDC Emerging Technologies Fund. I also realize that any misrepresentation of facts may result in a withdrawal of the award regardless of when discovered by the MEDC or SBDC, and that additional legal remedies may apply. 

Name and Title:Type (I AGREE): Date:

State Headquarters | Seidman College of Business | Grand Valley State University50 Front Avenue SW, Suite 1020 | Grand Rapids, MI 49504-6424

(616) 331-7480 | www.SBDCMichigan.org