NIH Applicant Assistance Program Application Only one application may be submitted per company for each round of the AAP. "*" indicates required fields Applicant Information (only 1 application per company is allowed)1. Applicant Name*(PI on proposed application) First Last Phone Number*Alternate PhoneEmail Address* Enter Email Confirm Email 2. Applicant role within company (e.g. Founder, CEO, Senior Scientist, etc.)* 3A. 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 or Corporation) of your company here:* 4. Where is the operating location of the Small Business?* Street Address Address Line 2 City ZIP / Postal Code State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAmerican SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPuerto RicoPalauVirgin Islands5. Will a University be affiliated with the project?* Yes No Please list 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-groupsWoman Ownership* 0% 1% - 51% > 51% Prefer not to answer Underrepresented Ownership* 0% 1% - 51% > 51% Prefer not to answer 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 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 NIH 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 (If you select "Yes", you are ineligible to apply for the 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 2013 (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 Information11. 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 if other, please specify 12. Project Title (limit 200 characters)* 13. 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.14. The Unmet Need. (Up to 1,500 characters)*Instructions: Describe the problem you are trying to solve and how this will improve human health.15. Which Institute Are You Applying To?*Please carefully read through the following mission statements for each IC and select only one IC for consideration in the drop down below.: NHLBI: LINK The National Heart, Lung, and Blood Institute (NHLBI) provides global leadership for a research, training, and education program to promote the prevention and treatment of heart, lung, and blood diseases and enhance the health of all individuals so that they can live longer and more fulfilling lives. NCI: LINK NCI’s mission is to lead, conduct, and support cancer research across the nation to advance scientific knowledge and help all people to live longer, healthier lives. NCI’s scope of work spans a broad spectrum of cancer research across a variety of disciplines. The Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) Programs are NCI's engine of innovation for developing and commercializing novel technologies and products to prevent, diagnose, and treat cancer. NIA: LINK The National Institute on Aging small business programs support research and product development focusing on aging and aging related conditions and diseases, including Alzheimer’s disease and related dementias, as well as other problems and needs unique to older adults, their caregivers, and providers. For additional information about NIA small business research priorities, click here. NIDCD: LINK NIDCD conducts and supports biomedical and behavioral research and research training in the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language. The institute also conducts and supports research and research training related to disease prevention and health promotion; addresses special biomedical and behavioral problems associated with people who have communication impairments or disorders; and supports efforts to create devices that assist individuals with hearing loss or other communication disorders. NCATS: LINK NCATS' mission is to catalyze the generation of innovative methods and technologies that will enhance the development, testing, and implementation of diagnostics and therapeutics across a wide range of human diseases and conditions. NCATS is improving health through smart science. NINDS: LINK The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease for all people. NIEHS: LINK The mission of the NIEHS is to discover how the environment affects people, in order to promote healthier lives. The Vision of the NIEHS is to provide global leadership for innovative research that improves public health by preventing disease and disability. The SBIR and STTR programs at the NIEHS help small businesses develop innovative applications to translate and communicate environmental health research to improve public health. NIAAA: LINK The National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducts and supports research to expand and disseminate fundamental knowledge about the effects of alcohol on health and well-being, and apply that knowledge to improve diagnosis, prevention, and treatment of alcohol-related problems, including alcohol use disorder, across the lifespan. NIAAA’s Small Business Innovation Research (SBIR) and Small Business Technology Transfer Research (STTR) programs support small businesses, researcher organizations, and entrepreneurs developing and commercializing treatments, technologies, and solutions in this field. NINR: LINK The mission of the National Institute of Nursing Research (NINR) is to promote and improve the health of individuals, families, and communities. NICHD: LINK NICHD’s mission is to lead research and training to understand human development, improve reproductive health, enhance the lives of children and adolescents, and optimize abilities for all. NICHD is interested in Small Business Innovation Research/Small Business Technology Transfer (SBIR/STTR) activities that help fulfill its mission. Specific branch priorities are explained here: https://www.nichd.nih.gov/grants-contracts/SBIR_STTR/priorities Select your ICNational Cancer Institute (NCI)National Institute of Neurological Disorders and Stroke (NINDS)National Institute on Aging (NIA)National Heart, Lung, and Blood Institute (NHLBI)National Institute on Deafness and Other Communication Disorders (NIDCD)The National Center for Advancing Translational Sciences (NCATS)The National Institute of Environmental Health Sciences (NIEHS)The National Institute on Alcohol Abuse and Alcoholism (NIAAA)The National Institute of Nursing Research (NINR)Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)16. Please select an IC from the previous dropdown-menu* 16. Explain how your project fits within NHLBI's mission. (Up to 1,500 characters)*16. Explain how your project fits within NCI's mission. (Up to 1,500 characters)*16. Explain how your project fits within NIA's goal. (Up to 1,500 characters)*16. Explain how your project fits within NIDCD's mission. (Up to 1,500 characters)*16. Explain how your project fits within NCATS' mission. (Up to 1,500 characters)*16. Explain how your project fits within NINDS' mission. (Up to 1,500 characters)*16. Explain how your project fits within NIEHS' mission. (Up to 1,500 characters)*16. Explain how your project fits within NIAAA's mission. (Up to 1,500 characters*16. Explain how your project fits within NINR's mission. (Up to 1,500 characters)*16. Explain how your project fits within NICHD's mission. (Up to 1,500 characters)*17. Describe the current state of your technology (i.e., concept, prototype phase, in vitro testing, etc.). (Up to 200 characters)* 18. 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.Accepted file types: pdf, png, jpg, Max. file size: 10 MB.19. 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.20. Describe your strategy to protect your technology from competitors (i.e., patents, copyright, etc.)? (Up to 500 characters)*Network21. What resources to develop your SBIR/STTR application 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 If other, please specify 22. 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 23. List additional areas in which you need support for your SBIR/STTR proposal:* 24. Do you agree to spend 10-25 hours per week during the training period working on your SBIR/STTR application?* Yes No 25. How did you hear about the AAP?*AAP websiteAn NIH websiteHHS Small Business Program ConferenceTwitterLinkedInPO referralPrevious participantEmail from NIH/EGCEmail from a 3rd partyOtherPlease Specify CAPTCHA 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.