Application: NIH Applicant Assistance Program (AAP) - Eva Garland ConsultingEva Garland Consulting

Applicant Information

1. Applicant Name*

(PI on proposed application)

First Last

Phone Number*

Alternate Phone

Email Address*

Enter Email Confirm Email

2. Applicant role within company (e.g. Founder, CEO, Senior Scientist, etc.)*

3A. A company must be established prior to applying for AAP. Please enter the name of your company here:*

3B. Please enter the structure (e.g. LLC, Corporation, etc.) of your company here:*

4. Where is the operating location of the Small Business?*

Street Address Address Line 2 City ZIP / Postal Code

State*

State

5. Will a University be affiliated with the project?*

Yes
No

Name of University

6. Description of Women and Minority Involvement in SBC Ownership and Leadership*

The following racial and ethnic groups have been shown to be underrepresented in health-related sciences in the United States: African Americans, American Indians and Alaska Natives, Hispanics (or Latinos), Native Hawaiians and other Pacific Islanders. For more information: https://extramural-diversity.nih.gov/diversity-matters/underrepresented-groups

Woman Ownership

% owned

Underrepresented Ownership

% owned

Please describe woman/underrepresented group involvement in Founder and C-Suite roles (if applicable)

Woman Founder
Woman in C-Level Leadership Role
Founder from an Underrepresented Group
C-Level Leader from an Underrepresented Group

What race/ethnicity does the Founder identify with?

African American
American Indian and Alaska Native
Hispanic (or Latino)
Native Hawaiian
Other Pacific Islander
Other
Prefer Not To State

What race/ethnicity does the C-Level Leader identify with?

African American
American Indian and Alaska Native
Hispanic (or Latino)
Native Hawaiian
Other Pacific Islander
Other
Prefer Not To State

7. Are you seeking support through the AAP to help prepare a new SBIR/STTR application or to assist you in resubmitting an amended application?*

New Application
Resubmission

If a resubmission, please enter previous grant number.

8. Does the small business or PI have an NIH SBIR/STTR application with the same scope of work under review?*

Yes (Ineligible for AAP)
No

9. What is the previous experience of the small business with NIH SBIR/STTR funding?*

Have not applied
Have not been successful
Have received NIH SBIR/STTR award(s) in the past 10 years (Ineligible for AAP)
Have received NIH SBIR/STTR award(s), with the most recent award received prior to 2010 (Eligible for AAP)

10. What is the previous experience of the proposed project Principal Investigator (PI) with NIH SBIR/STTR Funding?*

Have not applied
Have not been successful
Have received NIH SBIR/STTR award(s)

Technology Information

1. What type of technology will you be developing in your proposed SBIR/STTR project?*

Drug
Research Tool
Combination Product
Medical Device
Diagnostic
Health IT / Education
Other

Please Specify

2. Project Title (limit 200 characters)*

3. The Technology Innovation. (Up to 1,500 characters)*

Instructions: Describe the innovation that will be the focus of your Phase I SBIR/STTR project. Briefly discuss the benefits compared to competing technologies.

4. The Unmet Need. (Up to 1,500 characters)*

Instructions: Describe the problem you are trying to solve and how this will improve human health.

5. What Institute Are You Applying To?*

National Cancer Institute (NCI) LINK
National Institute of Neurological Disorders and Stroke (NINDS) LINK
National Institute on Aging (NIA) LINK
National Heart, Lung, and Blood Institute (NHLBI) LINK
The National Center for Complementary and Integrative Health (NCCIH) LINK
The National Center for Advancing Translational Sciences (NCATS) LINK
The National Institute of Environmental Health Sciences (NIEHS) LINK
The National Institute of Nursing Research (NINR) LINK

6. Fit within the NIH Institutes and Centers' mission. (Up to 1,500 characters)*

Instructions: Explain how your project fits within the mission of the institute that you are applying to.

7. Describe the current state of your technology (i.e., concept, prototype phase, in vitro testing, etc.). (Up to 200 characters)*

8. Describe the premise that supports the scientific rationale for your proposal (upload 1 page pdf only).*

Instructions: Please make sure to clearly distinguish the preliminary data generated by your company and/or your collaborators versus data that is from public knowledge. Upload a pdf file of 1 page or less. Figures and tables may be included. Any text over 1 page or links to external materials (i.e., web links, etc.) will not be reviewed.

9. NIH SBIR/STTR Phase I Goals and Milestones. (Up to 3,000 characters)*

Instructions: Describe the scope of work to be completed in your Phase I SBIR/STTR project. Include a discussion of the developmental milestones that will be accomplished to advance the commercial development of your technology.

10. Describe your strategy to protect your technology from competitors (i.e., patents, copyright, etc.)? (Up to 500 characters)*

Network

1. What resources are available to you?*

Registration support
Proposal writing/development
Proposal review
Budget preparation
Expertise in technology development
Access to Key Opinion Leader(s)
Physical location to carry out the proposed work
Support in uploading and submitting proposal
Other

Please Specify

2. Have you reached out to your local SCORE or SBDC for assistance with any aspect of your small business?*

Visit SCORE or visit SBDC for more information

Yes
No

3. List additional areas in which you need support for your SBIR/STTR proposal:*

4. Do you agree to spend 10-25 hours per week during the training period working on your SBIR/STTR application?*

Yes
No

5. How did you hear about the AAP?*

Please Specify

Before submitting, please ensure that your email address and phone number have been accurately entered, as they will be used to notify you regarding your application status.

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