Maine Technology Institute - Development Award Application

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Grants & Awards > Development Awards > Development Award Registration

Development Award Registration

Please fill out and submit this form. Submitting this form will generate a printable version of the completed Form A. Please print, sign and return Form A with your application. ^*Indicates required field.

1. Project Title ^* (50 characters max)

2. Technology Sector(s) that best fit your business

The selected sector boards will evaluate and rank order proposals. Check all sectors that apply on the left. Regardless of the number of sectors you choose, please select one as preferred.

Technology Sectors ^*		Preferred ^*
	Advanced Technologies for Forestry and Agriculture
	Aquaculture and Marine Technology
	Biotechnology
	Information Technology
	Composite Materials Technology
	Environmental Technology
	Precision Manufacturing Technology

3. Development Stage(s) (check all that apply)

Proof of Concept/Feasibility
Prototype Development
Alpha, In-House Test
Product Development / Refinement
Beta Site Test
Design for Manufacturing

4. Award Amount Requested ^* (Numbers and commas only).

5. Matching Funds Amount and Source(s)

Please enter as many of your top 3 sources for matching funds below. For amounts, please use only numbers and commas. If a source is unknown, you may type unknown.
Amount ^*	Source ^*	Type ^*
$
$
$

6. Business Contact Information

Business Name ^*
Business Address ^*
Address Line 1 ^*
Address Line 2
City ^*
State ^*	Zip Code ^*
County ^*
Phone ^*	() - -
Fax Number	() - -
EIN	- (Employer Identification Number)
NAICS code if known	(formerly Business Standard Industrial Code (SIC))
No. of Years in Business ^*
No. of Full-Time Employees ^*
Business Stage ^*
Business Description ^* (150 Characters Max)	150 characters left
Business Type ^*	Sole Proprietorship Limited Partnership Non Profit Corporation Limited Liability Corp. Other (please describe)

7. Principal Contact Information

First Name ^*	M.I.	Last Name ^*	Suffix (Jr/Sr/III)

Job Title ^*(30 characters max) 30 characters left
Home Address ^*
Address Line 1 ^*
Address Line 2
City ^*
State ^*	Zip Code ^*
Home Phone ^*	() - -
E-mail	(A copy of this application (in PDF form) will be e-mailed to you, if you provide a valid e-mail.)
Other principals involved in project:

8. Proposal Information

If you have received MTI Development Awards or Seed Grants in the past, please list your 3 most recent below. For amounts, please use only numbers and commas.
	Proposal ID (Eg, DA5555 or SG5555)	Amount
		$
		$
		$

Is this proposal a resubmission? ^*	Yes No
Filed With Secretary of State?^*	Yes No
If no, state reason
Expected commercialization date

9. Names from which to withhold proposal information or "None":^*

Unless otherwise indicated, Full Proposals will be evaluated by the selected technology sector board members, the MTI Board of Directors and outside peer review experts.

Please review all information for accuracy before submitting.

If all information is correct, there may be a short (approx. 9 seconds) delay while we process your application. Please only click the Submit button once.

405 Water Street, Suite 300 · Gardiner, Maine 04345 · Ph: (207) 582-4790 · Fax: (207) 582-4772

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