Proof-of-Concept Form | Connecticut Innovations Connecticut Innovations

Section I

The initiative is led by Connecticut Innovations and CTNext. Before you complete the form for more information, we encourage you to review the FAQ, which provides answers to some common questions about the process and eligibility. If you review the criteria and believe your company is a fit, complete the form below to start the process. Please reach out to Tamyra Davis (Tamyra.Davis@ctinnovations.com), investment specialist at Connecticut Innovations, if you have any questions.

Contact name*

Name of company*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Investment pitch deck*

The investor deck should include the company’s leadership and team, company and technology/product, value proposition and desired outcomes of funding, target market and strategy, business model and project plan.

Business plan

The business plan is optional. Business plans should include an executive summary, value proposition and business structure, market strategy, management team and the financial state of the company.

Financials*

Financials should include the most recent balance sheet, cash flow and income statements. A sources and uses document surrounding the request for funding through this initiative should also be included.

Is the company minority-owned?*

Yes
No

To better understand the companies we work with and to further our goal of diversity in our business endeavors, we are also requesting the following information about company owners.

The founder/owner is (please select):*

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Native American or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.
I do not wish to answer this question.

Is the company woman-owned?*

Yes
No

Is the company veteran-owned?*

Yes
No

Is the company disabled-owned?*

Yes
No

To date, what is your biggest barrier in growing your business?*

Were you referred to the Proof-of-Concept Initiative?*

Yes
No

If yes, by whom?

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