Project Title

Principal InvestigatorTotal funds requested:

Confidential

1

Schematic, Illustration, etc.

Problem Statement (What unmet need is addressed by technology)

Summary of TechnologyBusiness Opportunities

Confidential

2

Current State of Technology(Include OTM Invention Disclosure #, TFXXXXX)

What is required to further marketability

Business opportunities for technology(Market, applications, who will use)

Proof of Concept Aims

Dates Major Milestones Deliverables

Confidential

See Supplementary Information for Detailed Budget

3

Planned Next Steps if POC is SuccessfulConfidential

4

Supplementary Information

5

Deliverables Time Period Budget

Detailed Proof of Concept Deliverables and BudgetConfidential

6

7

Additional Information

(If applicable, this space can be used to highlight Principal Investigator’s commercialization and entrepreneurial experience and/or interest in starting a company.)