Incubator Fund by xov14698

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									                                         State of New Jersey
                          New Jersey Commission on Science and Technology

                                     Incubator Seed Fund Grant
                                     Guidelines and Application

Program Description
The Commission’s Incubator Seed Fund is designed to accelerate the business development process and
produce significant value for the companies receiving the awards. The Incubator Seed Fund will provide, on a
competitive basis, funds to assist emerging businesses achieve a critical milestone in their commercialization
path. The direct financial support from the Commission will compliment the mentoring and business support
provided by incubator managers as they assist these emerging companies in commercializing their technologies.
The Commission will award grants to New Jersey companies in the amounts of $20,000 to $50,000.

Timetable for Required Submission
The following timeline will be applicable to this announcement. Incomplete applications on the due dates may
result in the proposal not being reviewed or considered.

          FUNDING CYCLE                       APPLICATION DUE                    AWARDS MADE

        First Round Funding             February 25, 2010 – 3:00pm                  May 2010


Company Eligibility
To be eligible for the Incubator Seed Fund Grant, the incubator client company must meet the following
requirements:

        A technology-based business that is a resident or virtual client of one of the NJCST supported
         incubators
        The applicant’s primary business is the provision of a scientific process, product or service and the
         applicant owns, has filed for, or has a license to use protected, proprietary intellectual property.
        At least 75% of employees live and work in New Jersey
        Companies are limited to one (1) Incubator Seed Fund award.
        Companies that have received the Edison Innovation R&D Fund or the Edison Innovation Clean Energy
         Fund are ineligible to apply for the Incubator Seed Fund Grant

Companies applying for any Commission grant must be in compliance with the terms of all previous
Commission awards in order to be considered for funding.

Principal Investigator

To be awarded a grant, the primary employment of the Principal Investigator must be with the Lead Company
at the time of the application and during the conduct of the proposed research. Primary employment means that
no less than 30 hours per week is spent in the employment of the Lead Company during the conduct of the
project and no more than 19 hours per week spent in the employment of another organization.

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  ___________________________________________________________________________
                       NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
                                    INCUBATOR SEED FUND
                                    Incubator Seed Fund Grant
Applicant Company Principal Investigator Information (please print or type)

Principal Investigator
& Title (Project Lead)
Company Name

Address

City                                                  State    Zip Code        Cell Phone


Telephone (business)                                  Fax                    Edison Innovation Zone Location
                                                                                Yes       No
E-mail Address                                                                                Year Started

Company Website Address:                                                     Tax I.D. Number:


Amount Requested                    Company Match                            County


Total Number of Employees:          Number of Employees Living in NJ:        Number of Employees working in NJ:


Number of Full-Time Employees::     Total Number of Employees of Parent      Annual Revenues
                                    and Subsidiary Companies living in
                                    New Jersey:

For each employee, please provide place of residence, municipality, county, and state. Attach
additional sheets if necessary.
                                                                                  Hours         Indicate whether
          Employee Name                Municipality           County/State        Worked          W-2, 1099 or
                                                                                 Per Week             other




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  ___________________________________________________________________________
                         NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
                                      INCUBATOR SEED FUND
Project Summary
Provide a one page brief description of both the company and the proposed project. PLEASE USE NON-TECHNICAL,
LAY LANGUAGE. Do not include proprietary or confidential information. If the application is funded, this description
will be made public. The specific aims of this project should be in BOLD
 Project Title
 Please provide a brief project summary (no more than 200 words)




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   ___________________________________________________________________________
                       NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
                                    INCUBATOR SEED FUND
          Section VIII: Eligibility and Disclosures
          Have any of the persons or entities listed above:

          been, within the last five years, a party in litigation?

                   Yes                 No

          been, or is now, charged with, convicted of, under indictment, on parole, on probation or a plaintiff, defendant or other
          party in, any criminal or civil offense other than a minor motor vehicle violation?

                   Yes                 No

          been, or is now, subject to, or has pending, any disciplinary action by any administrative, governmental or regulatory
          body?

                   Yes                 No

          been, or is now, subject to any order resulting from any criminal, civil or administrative proceedings brought against such
          persons or parties by any administrative, government or regulatory body?

                   Yes                 No

          been, or is now, denied any license by any administrative, government or regulatory agency on the grounds of moral
          turpitude?

                   Yes                 No

          been, or is now, informed of any current or on-going investigation with respect to possible violation by such persons or
          parties of state or federal securities, anti-trust or criminal laws?

                   Yes                 No

          been, or is now, denied a business or professional-related license or had it suspended or revoked by any administrative,
          government or regulatory agency?

                   Yes                 No

          been, or is now, disbarred, suspended or disqualified from contracting with any federal, state or municipal agency?

                   Yes                 No

          been, or is now, in receivership or adjudicated bankrupt?

                   Yes                 No

          been, or is now, in default on a personal or business loan?

                   Yes                 No

          is now involved in any pending lawsuits?

                   Yes                 No


If the answer is “yes” to any of the questions above, furnish details on a separate page under the heading “ELIGIBILITY
AND DISCLOSURES”. Any information you wish to submit that may expedite this investigation should be set
forth as an attachment.

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             ___________________________________________________________________________
                                     NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
                                                  INCUBATOR SEED FUND
Application Affidavit


I, THE UNDERSIGNED, BEING DULY SWORN UPON MY OATH SAY:

1. I affirm, represent and warrant that the information contained in this application and all attachments
submitted herewith is true and complete to the best of my knowledge and that the grant applied for herein is not
for personal, family or household purposes.

2. I understand that if such information is willfully false or eligibility for the Commission’s Edison Innovation
R&D Fund is falsely certified I am subject to criminal prosecution under N.J.S.A. 2C:28-1, 2C:28-2 and 2C:28-
3, as applicable and civil action by the Commission which may at its option terminate its grant.

3. I authorize the New Jersey Department of Law and Public Safety to verify any answer(s) and information
contained herein through a search of its records or records to which it has access and to release the results of
said research to the Commission.

4. I authorize the Commission to obtain such information including, but not limited to, a credit bureau check as
it may require, covering the applicant and/or its principals.

5. I understand that the Commission will retain this application and all associated documents, whether or not
this application is approved.


_______________________________________________
Signature of Applicant



________________________________________________
Name and Title of Applicant (Print or Type)


_________________
Date



                                                 Sworn and Subscribed before me this ___ day of ___ 20__



                                                 ________________________
                                                 NOTARY PUBLIC




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                       NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
                                    INCUBATOR SEED FUND
Budget:

          Applicant Budget



     NJCST Grant
                                                                                               FICA/Fring
                             Role on
     Name                                              % Effort    Type Appt.      Salary          e
                             Project
                                              Staff   on Project    (months)      Requested     Benefits    Total




                                                               Total


     Company Funds
                             Role on                   % Effort    Type Appt.      Salary     FICA/Fringe
     Name
                             Project          Staff   on Project    (months)      Requested     Benefits    Total




                                                               Total




                                                           NJCST                Company         Federal     Other
     Expense Category
     Direct Expenses (itemize)
     Personnel (see above
     details)
     Sub-Contractors/Consultants (itemize)
     Travel (itemize)
     Supplies (Itemize: Specific Supply and
     Cost)
     Equipment (Itemize: Specific Equipment
     and Cost)
     Other

     Total Anticipated Expenditures




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             ___________________________________________________________________________
                                 NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
                                              INCUBATOR SEED FUND
I certify that all information that I have provided in this application is correct to the best of my knowledge. I understand that the
Commission will retain this application and all associated documents, whether or not this application is approved. I understand that the
Commission may obtain a credit report concerning the applicant firm. I certify that the company has met all the eligibility requirements
for the Incubator Seed Fund.


I understand that deliberately making false statements on this application, or falsely certifying eligibility for the Incubator Seed Fund is
prohibited under Section 2C:28-3 of the New Jersey Code of Criminal Justice, and is punishable by fine or imprisonment.




_______________________________________________________                   ____________________________________________________
Signature of Applicant                 Date                                               Name and Title of Applicant (Print or Type)




Application Submission

Send the original signed copy of the Application and the complete Grant Proposal on a CD in PDF
format to the Commission at the address below.

Overnight:
New Jersey Commission on Science and Technology
Incubator Seed Fund Grant
10 South Montgomery Street
Trenton, NJ 08625

U.S. Postal Service:
New Jersey Commission on Science and Technology
Incubator Seed Fund Grant
P.O. Box 832
Trenton, NJ 08625

For Additional Information

Please contact the New Jersey Commission on Science and Technology at (609) 984-1671 or
njcst@scitech.state.nj.us.

Note: To receive funding companies must be registered with the State of New Jersey Division of Revenue. If not
registered you can do so at http://www.state.nj.us/treasury/revenue/index.html




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   ___________________________________________________________________________
                             NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
                                          INCUBATOR SEED FUND

								
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