To submit an application to BioAdvance for funding please answer each of the questions below and then click on the "CONTINUE" button. This will take you to the page where you should upload your Non-Confidential Executive Summary and Business Plan, Proposal or recent Ben Franklin Application.  Please note you will not be able to save this form and come back to work on it at a later time; therefore, we suggest answering the questions below in a separate Word document, preparing your executive summary and business plan/proposal then coming back to this online form and pasting your answers in all at one time.  Once you have completed that, click “CONTINUE”, this will take you to a page where you can upload your executive summary and business plan.

We recognize that many early-stage companies/individuals have not yet written a formal business plan.  If you do not have a formal business plan, BioAdvance offers an alternative course by providing a list of questions for you to answer in a formal proposal which also meets the application requirements of BioAdvance.  These questions can be found in Appendix B of our Request for Proposals document.  Applicants may also submit their recent (within last 6 months) Ben Franklin application in lieu of a business plan.

Academic researchers applying for funding should upload a description of their technology and potential products, a description of the use of funds, and an overview of the underlying intellectual property.

Once you have uploaded the requested documents click the "SUBMIT" button. This will complete the registration/application form. If you experience difficulties or have questions about this form please email mmccoy@bioadvance.com.

Step 1 of 2: Enter Registration Information

1.	Title of Proposal (Limited to 80 characters)
	Enter a name for your proposal that clearly describes your effort as concisely as possible. Choose a title that specifically describes the proposed effort rather than a generality.
2.	Name of Organization or Individual Making Application
	Enter the name of the organization making the request, or if the applicant is an individual, enter the name of the individual applying.
	Individual Nonprofit Organization For Profit Organizaiton
3.	Applicant Contact Information
	Enter the contact information for the project manager or key contact for this application. Even if you entered the name of an individual in Question 2 above, you must still enter the name of a contact person here, even if it is the same person.
	Include this person on all email correspondence First Name: Last Name: Address:   City: County State: ZIP Country Email: Phone: Alternate Phone: Fax:
4.	Principal Scientist (OPTIONAL)
	If there is a principal scientist responsible for this project, identify that person here. If not, or if the principal scientist is the same as the contact person, skip and go to the next question.
	Include this person on all email correspondence First Name: Last Name: Address:   City: County State: ZIP Country Email: Phone: Alternate Phone: Fax:
5.	Technology Focus
	First, select the primary category within which your technology focus fits. You must select only one primary category. Chose the most appropriate primary technology focus category based on the definitions provided. Next, you may choose as many secondary categories you wish (or none at all). If you choose a category as either a primary of secondary project focus, you are required to complete the additional information requested for that category.
	Agents for the prevention, mediation or treatment of diseases or conditions of humans. Technologies that facilitate the discovery or design of therapeutic agents or diagnostics. Tests, instruments or agents used in the diagnosis of diseases or conditions of humans. Mechanical devices or physical agents (such as drug delivery agents) used either directly or indirectly to diagnose, prevent or treat diseases of human. PRIMARY SECONDARY (OPTIONAL) CATEGORIES Therapeutics     Disease(s) or condition(s) to be treated:   Tools or platform technologies     Utility:   Devices     Disease(s) or condition(s) to be treated:   Diagnostics     Disease(s) or condition(s) diagnosed:   Other     Describe below:
6.	Proposal Summary (Limit to 2000 characters)
	Summarize the use of funds and the technical or commercial objective of the funding requested.
7.
8.	Total amount of funding requested this cycle ($500,000 maximum)
	What is the total amount you are requesting for this funding round? On the application, you will be asked to provide a budget and justifications for your projections. If the amount you are requesting is over $500,000, your application will not be considered.
	$
9.	Total Project Cost
	What is the projected total project cost to achieve your proof-of-concept? You will be asked in the application to identify other sources of funds, committed and/or potential.
	$
10.
11.	Location of Work (OPTIONAL)
	Identify the physical location of the facility where your research will be conducted? If you do not list a location within Southeastern Pennsylvania, you may be ineligible for BioAdvance funding.
	City: County: State: ZIP Country:
12.	Number of Current Employees
	For corporate applicants, please list the number of current employees in Southeastern Pennsylvania
13.	Suggested Technical Reviewers (optional)
	Applicants have the opportunity to suggest up to three experts from the academic community or industry to provide a technical review. These should not be individuals who currently or in the past have had a relationship (e.g., collaborator, co-author, advisor, etc.) with the applicant. The reviewer should not be employed or affiliated with an academic or research institution in Southeastern Pennsylvania that is eligible to seek funds from BioAdvance. Technical reviewers are compensated for their time and asked to certify that there are no conflicts before reviewing an application. The goal is to obtain the highest quality technical review. BioAdvance may use one or more or none of the reviewers suggested. If there are particular technical reviewers you would like to exclude from reviewing your application, please send an email to application@bioadvance.com including the project title and the name and affiliation of the reviewer to be excluded.
	Reviewer A First Name: Last Name: Institution or Affiliation: Field of Expertise: Email: Phone: Reviewer B First Name: Last Name: Institution or Affiliation: Field of Expertise: Email: Phone: Reviewer C First Name: Last Name: Institution or Affiliation: Field of Expertise: Email: Phone: