D’Works Innovation Fund Application Step 1 of 5 20% Thank you for applying to our Innovation fund as part of the D’Works Marine Technology Initiative for Massachusetts Startups. Our goal is to support access of early stage Massachusetts marine start-ups to WHOI ocean prototyping and test facilities and to support technical challenges as needed. This application includes the following sections: Section 1: Innovator/Company Information Section 2: Determining Outcomes Section 3: Business Challenges and Support Needs Section 4 : Contact Information Section 5: Agreement and Signature (View Terms & Conditions) Section I: Innovator/Company InformationName of Company* Location of Company Headquarters or Innovator’s Base of Operations (City, State)* When did you first start this business? (Month/Year)* Number of employees* What type of organization are you? Sole proprietorship Partnership Corporation Limited Liability Company Other Describe Section 2: Determining OutcomesPlease identify the specific milestones that you seek to achieve with D’Works Innovation funding.*Please provide a detailed, concise description of how the funding will advance the business planning and execution of your current business thinking toward those milestones.*Please provide an explanation of the markets that the product or service will address and the size, expressed in dollars, of that market. Include if this market within the United States Any overseas markets?*Please explain how a successful project will help this company move toward marketing and selling its products and services in the marketplace.*From what other sources or entities is your company receiving funding or other support?*If none, are you self–funding from personal resources? Section 3: Business Challenges and Support NeedsPlease describe one or two main challenges facing your company as you make this application. For each, please provide some context and be descriptive.*1,000 word maximumBased on the Facility Access table, please describe the access you are seeking and, the technical needs, if any, you would like help addressing.*1,000 word maximum Section 4: Contact InformationName* First Last Office/Mobile Phone*Email* Job Title* Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Is your company a certified women-owned or minority-owned business?* Yes No Section 5: Agreement and SignatureConsent* By signing this form you acknowledge that you have reviewed the TERMS AND CONDITIONS. If you are accepted into the D'Works Marine Technology Initiative, you will be asked to sign the Participation Agreement at that time.Today's Date* MM slash DD slash YYYY Electronic Signature*By checking the above consent and printing your name below, you are agreeing to be bound by the Terms & Conditions. If any information in this application materially changes, please notify us. NameThis field is for validation purposes and should be left unchanged. Δ
