UMass IC Application Form Intent to Compete Form & Certificate of Eligibility - 2012/13 Company/team name * Name, affiliation (include degree program), and telephone number for all team members * Email addresses for all team members * Names and affiliations of faculty and other advisors Recommended, but not required for MinutePitch entries. Names and affiliations of investors from whom you have secured investment as well as amount of the investment received or promised This does not include you or your family. Brief description of your business idea * Describe the market/customer * Describe what makes your idea unique in the market * Is there any reason why you feel your team may not be eligible to compete in the Innovation Challenge? * Yes No If yes, please explain * Is the team leader the owner of the idea, concept, or technology you are presenting in the Innovation Challenge? * Yes No If no, please be sure to provide proper documentation from the owner authorizing the use and public disclosure of the technology/idea in the Innovation Challenge. Contact us with questions. * Optional video You are encouraged to record a 1-3 minute video that showcases you pitching your idea. You may use a camera phone, video camera, computer camera, etc. and will not be in any way judged on the quality of the video. Links to video clips should be e-mailed to Heather Demers at demers@ecs.umass.edu. YouTube and Dropbox are recommended. In your video pitch you should quickly answer the following five questions: What's the PROBLEM your product or service addresses? What's your SOLUTION? Who are your customers – how large is the MARKET? Who is the COMPETITION? What advantages make you so SPECIAL? Will you be submitting a 1-3 minute video? * Yes No Not sure If yes, please email links to Heather Demers at demers@ecs.umass.edu Please indicate which competitions you would like to be considered for. * Fall MinutePitch Fall Executive Summary & Elevator Pitch Spring Minute Pitch Spring Mini Plan (this is where you compete for a slot in the Final Business Plan event) You can add/change competitions at any time by contacting Heather Demers By submitting this form, we verify that we have read the qualifications for entry, and certify that the team meets the terms for entry listed in the eligibility section on the compete page. By submitting this form, you accept the Mollom privacy policy.