Company Name

Country Code

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Company Country Code

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Company Phone Number

Enter a valid phone number without space (eg., 9876543210)

CEO Information

First Name	Last Name
Country Code Search and select country code for phone number.	Phone Number Enter a valid phone number without space (eg., 9876543210)
Email Address	LinkedIn URL
	CEO Country Code This will hold the selected Country name's code

Is the preparer of this form also the CEO?

Preparer's Information (if different than CEO)

First Name	Last Name
Country Code Search and select country code for phone number.	Phone Number Enter a valid phone number without space (eg., 9876543210)
Email Address	LinkedIn URL
Job Title	Prep Country Code This will hold the selected Country name's code

Account Type

Date Founded

Address Line 1

Address Line 2

City

Country

State

Provinces

State/Province

Postal Code

Company Website

Company LinkedIn URL

Number of Employees

Would you like to add additional team members?

Additional Team Members

First Name	Last Name
Country Code Search and select country code for phone number.	Phone Number Enter a valid phone number without space (eg., 9876543210)
Email Address	LinkedIn URL
Job Title	Member Country Code This will hold the selected Country name's code
Member Phone with Code

Stage (Idea, Incorporated, Seed Funded, Series A)

Technology Area

Short Description of your Technology

How did you hear about Silicon Catalyst?

Problem or Market Opportunity

Solution/Product to be Developed

Use of Semiconductors in Solution, Semiconductor type (ASIC, ANALOG-M/S, CPU, MEMORY, MEMS, ETC.), Technology Node (E.G., 180NM)

Current or Expected Customers

Potential Market Size (Initially and Ultimate)

Describe Your Business Model

Competitors & Alternatives

Competitive Advantage

Intellectual Property

Intellectual Property (describe)

Go to Market (Marketing & Sales) Strategy

Feasibility Demonstration

Key Future Technical and Customer Milestones & Deliverables

Current & Desired Partnerships

What are your biggest challenges?

What are your greatest perceived risks?

What do you expect from Silicon Catalyst? (For example, in-kind partner tools and services, connection to potential advisors, funding support)

Is the Company involved in any current, pending, threatened, or recent (past 5 years) legal, regulatory, or investigative actions, whether as plaintiff or defendant?

Are any of the founders, officers, directors, or key employees involved in any current, pending, threatened, or recent (past 5 years) legal, regulatory, or investigative actions in connection to this Company or in connection with any prior company or role, whether as plaintiff or defendant?

Income or Revenue Expected in 12 & 24 Months: Describe the Source

Current Cash Balance & Monthly Cash Burn Rate

Amount of Funding Needed in 12 & 24 Months

Previous Funding & Capital Raised, & From Whom

Primary Expected Expenses by Major Category (Salaries, IP, Prototyping, Design Tools, 3rd Party Services, Office Space, IT)

Exit Strategy (Licensing, Acquisition, IPO)

Pitch Deck

Company Logo

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