Client Questionnaire This is the first step in our process of evaluating the technology you are developing. Please complete it to the best of your ability and a member of our team will reach out to you shortly Step 1 of 2 50% Name*Name of institution or company*Email* Please give a brief non-confidential description of the specific technology in question*What is your focus?*---Select---Pancreatic cancer, Lung cancerBoth pancreatic cancer and lung cancerNeither pancreatic cancer or lung cancerSkipper Bio Med is a chartiable research consultancy that offers services to assist the preclinical development of promising theranostics for speicifically lung or pancreas canse. Unfortunately, if your project does not focus on these two indications, Skipper Bio Med is not a good fir for you at this time*If you believe you are a unique case , please describe belowWhere is your technology currently being developed?*---Select---IndustryAcademiaWhat is the status of your intellectual property (IP)?*---Select---Provisional application not filedProvisional application filedTrade secret or other form of IPPatent filed or issuedWhy has a provisional application not been filed?* Tehnology is currently not patentable Tehnology requires more scientific development Other What is the patent status of your technology?* US Stage Foreign filing stage Issued/Granted How would you classify your company?*---Select---Start up company(palns to grow and exit, disruptive, scaleable)Small to mid sized company (steady long term revenue)What is the primary roadblock for your technology's development?*---Select---FundingStaffing/ lab resourcesRegulatoryOtherWhat is the primary roadblock for your technology's development?*---Select---FundingStaffing/ lab resourcesRegulatoryOtherWhat round of financing are you pursuing for your technology?*---Select---Pre-seedSeedSeries A/BI am seeking other types of fundingWhat source of funding are you pursuing for this technology?* Angel Investment Venture Capital Other Has a pitch deck been constructed for this technology?*---Select---NoYesHas the technology been communicated to any angel or VC investors?*---Select---NoYesWhy has the technology not been communicated to an angel/ VC investor?*---Select---It is not clear how to identify angel/ VC investorsSupport is needed to construct a pitch deckLimited time to contact angel/ VC investorsOtherHave you been presented a term sheet thus far?*---Select---NoYesPlease describe the investor feedback you have received thus far* What type of funding do you need our help in seeking?*---Select---Crowd FundingRegional Sources(ex CPRIT)Small Business GrantsPitch contest/challengeNo preference/ I need more informationPlease describe the progress towrd obtaining crowdfunding and describe any roadblocks*Please describe the progress towrd obtaining regional funding and describe any roadblocks*Please describe the progress towrd obtaining small business grants and describe any roadblocks*Has a pitch deck been constructed?*---Select---YesNoPlease describe the nature of your staffing/ lab resource needs*Please describe the nature of your regulatory needs*Please describe the nature of your funding needs*Please describe the nature of your staffing/ lab resources needs*Please describe the nature of your regulatory needs*Are you interested in commercializing your technology?*---Select---NoYesPlease describe the rationale for not wanting to commercialize your technology*Have you spoken to your tech transfer office about your technology?*---Select---NoYesPlease describe the rationale for not engaging with the tech transfer office*Has an invention disclosure been submitted for this technology?*---Select---NoYesPlease describle the progress towards preparing an invention disclosure and describe any roadblocks.*Did your tech transfer office express commercial potential in the technology?*---Select---NoStill in review by the tech transfer officeYesDid the tech transfer office provide a rationale for not filing a provisional application?*---Select---No/ Not yetYesWhat feedback did the tech transfer office give about your technology?*---Select---The technology needs more developmentNot patentable (Not useful, novel, non-obvious)The technology would not be competitive in current marketOtherWhat is the intellectual property (IP) status of your technology?*---Select---Provisional application not filedProvisional application filedTrade secret/ Other form of IPPatent filed or issuedWhy has the provisional application not been filed?*---Select---Alternative approaches being considered (material transfer agreement, sponsored research agreement, etc)Provisional application is still being written by the tech transfer officeAwaiting publication submissionOtherHas your tech transfer confirmed their intentions to file a patent yet?*---Select---NoYesWhat has prevented the patent from being filed*---Select---Lack of industry partnershipLack of evidence to support patent claimsOtherWhat is the patent status of your technology* US Stage Foreign Filing Stage Issued/Granted How would you like to continue developing this technology?*---Select---Industry PartnerForm own start upIm not sureIs the research for this technology currently being sponsored by an industry partner?*---Select---NoYesIs assistance needed in identifying funding source?*---Select---YesNoPlease describe the specific nature of your funding needs*Has the industry sponsor expressed interest in licesing the technology?*---Select---YesNoIs assistance needed in identifying licensing source?*---Select---YesNoHave you licensed your technology from the university?*---Select---YesNoAttempted but failed to reach an agreementHas a start-up already been formed?*---Select---NoYesWhat do you need help with?*---Select---Staffing/ lab resourcesBusiness plan developmentFundingProduct DevelopmentNoneOtherPlease describe the specific nature of your staffing/ lab resource needs*Please describe the specific nature of your business plan needs*Please describe the specific nature of your product development needs*If applicable please indicate the primary roadblock to your technology's development*---Select---Product developmentStaffing/ lab resourcesFundingNoneOtherPlease describe the specific nature of your product development needs*Please describe the specific nature of your staffing/ lab resource needs*What round of financing are you pursuing for your technology?*---Select---Pre-SeedSeedSeries A/BIm seeking other forms of fundingWhat source of funding are you pursuing for this technology?* Angel Investment Venture Capital Investment Other Has a pitch deck been constructed for this technology?*---Select--NoYesHas the technology been communicated to any angel or VC investors?*---Select---NoYesWhy has the technology not been communicated to an angel/ VC investor?*---Select---It is not clear how to identify angel/ VC investorsSupport is needed to construct a pitch deckLimited time to contact angel/ VC investorsOtherHave you been presented a term sheet thus far?*---Select---YesNoPlease describe the investor feedback you have received thus far*What type of funding do you need our help in seeking?*---Select---Crowd fundingRegional sources(example CPRIT)Small business grantsPitch challenge/ contestNo preference/ I need more informationOtherPlease describe the progress towrd obtaining crowdfunding and describe any roadblocks*Please describe the progress towrd obtaining regional funding and describe any roadblocks*Please describe the progress towrd obtaining small business grants and describe any roadblocks*Has a pitch deck been constructed?*---Select---YesNoIs your technology a drug or device?*---Select---DrugDevice (including lab developed test (LDT), molecular biomarker test, etc)What stage is your technology in?*---Select---Discovery Pahse (IND enabling studies not started)Pre-Clinical (IND enabling studies begun or about to begin)Clinical Trials (IND Submitted)I am not sureDo you have a lead drug candidate?*---Select---NoYesWhat hurdles if any is holding back your research?* Funding Staffing/ lab resources Time Experimental hurdles Other None of the above Please describe the specific nature of your funding needs*Please describe the specific nature of your staffing/lab resource needs*Please describe the specific nature of your experimental hurdles needs*If applicable please indicate the primary roadblock to your technology's development*---Select---FundingLab Resources/ PersonnelTimeExperiments within IND enabling studies not completeOtherPlease describe the nature of your funding needs*Please describe the nature of your staffing/ lab resource needs*What IND enabling studies have been completed thus far?* Chemistry manufacturing and control (CMC) Pharmacokinetics/ ADME (at least two different animal models, dose range finding) Toxicology (28 day study in at least two different animal models) None Please describe the specific nature of your clinical trial needs*Do you have a lab developed test or in vitro reagent?*---Select---YesNoIs your technology already available to patients as can LDT through CMS' CLIA program?*---Select---YesNoWhat is the next intended regulatory step for your technology?*---Select---Through CLIA (includes LDT)FDACLIA and FDAUndecidedNo further actionHas the technology been presented to a CLIA certified lab?*---Select---YesNoI dont have access to a CLIA certified labHave you presented the technology to the CLIA certified lab?*---Select---YesNoPlease describe rationale for not engaging with a CLIA certified lab*Has the technology been presented to a CLIA certified lab?*---Select---YesNoI don't have access to a CLIA certified labHas a CLIA certified lab agreed to test your technology?*---Select---NoYesPlease describe the roadblocks in engaging with a CLIA certified lab*What class device do you have?*---Select---Class IClass IIClass IIII need help decidingIs your technology a companion diagnostic?*---Select---YesNoAre you developing a therapeutic related to your device?*---Select---YesNoWhat stage is your technology in?*---Select---Discovery Pahse (IND enabling studies not started)Pre-Clinical (IND enabling studies begun or about to begin)Clinical Trials (IND Submitted)I am not sureDo you have a lead drug candidate?*---Select---NoYesWhat hurdles if any is holding back your research?* Funding Staffing/ lab resources Time Experimental hurdles Other None of the above Please describe the specific nature of your funding needs*Please describe the specific nature of your staffing/lab resource needs*Please describe the specific nature of your experimental hurdles needs*If applicable please indicate the primary roadblock to your technology's development*---Select---FundingLab Resources/ PersonnelTimeExperiments within IND enabling studies not completeOtherPlease describe the nature of your Funding needs*Please describe the nature of your staffing/ lab resource needs*What IND enabling studies have been completed thus far?* Chemistry manufacturing and control (CMC) Pharmacokinetics/ ADME (at least two different animal models, dose range finding) Toxicology (28 day study in at least two different animal models) None Please describe the specific nature of your clinical trial needs*
