Innovation Incubator Program Application

The information that you fill out below will be used to determine your eligibility for the Innovation Incubator Program at the 2013 SIIA Education Business Forum. Applications are due by October 4, 2013. All applicants will be assessed a $50.00 processing fee. The processing fee must be submitted before the application is reviewed by our panel of judges. Please note that previous applicants in this program will not be reviewed without a new or improved product or service.

CLICK HERE TO SUBMIT APPLICATION FEE

* Indicates Required Fields

2013 SIIA Education Business Forum Participation

For those selected to participate in the 2013 SIIA Education Business Forum Innovation Incubator Program: participation includes online presentations to educators & administrators for the Educators' Choice Award, attending the Forum, a presentation to Forum attendees during the Business Profiles session, demonstrating the innovation at the Incubator Showcase (table top exhibit is included) and Networking Reception, and the opportunity to meet with potential investors/business partners during the One-to-One Business Connections meetings. Each innovator selected for participation must pay a discounted registration fee. Participants will also qualify for two (2) additional discounted registrations to attend the Forum.

Note: Forum attendees will select the Most Innovative and Most Likely to Succeed innovators (one winner and one runner-up for each recognition). Other prizes will be announced soon.

Will you need any financial support to attend the 2013 Education Business Forum?
    Yes
    No

Contact Information

* First Name:
* Last Name:
Title:
* Company Name/Affiliation:
* Business Number:
Cellphone: (for use onsite if selected)
* Email Address:

About Your Innovation

* What is the name and URL of your innovative project, product or service? (limit to 50 characters)

Innovation Name:
URL:

* Your primary interest in participating in the Innovation Incubator Program at the Education Business Forum is to seek support and/or partnership opportunities for: (Check all that apply)

    Additional funding / investment
    Commercialization, licensing, or distribution by education partner
    Concept validation / market input
    Early pilot studies / field testing in education institutions
    Efficacy studies / research
    Other, please specify:

* How would you classify your innovation's primary educational application? (check all that apply)
    Assessment
    Data Management/Learning
    Digital Education Resource
    eTextbook
    Game / Simulation (including Platforms and Tools)
    Global Education
    Mobile Learning (Tablet / Smartphone)
    Online Learning
    Personalized Learning (1:1 Learning)
    Social Learning
    Professional Development
    Other / Emerging Technology, please specify:

* Who is the end user for your innovation? (Check all that apply)
    Administrator
    Faculty
    Parent
    Student, Age/Grade Range:
    Other, please specify:

* What markets will your Innovation serve? (Check all that apply)
    Adult education
    Elementary
    ESL/ELL program
    Higher education/postsecondary
    Home school
    Middle school/junior high
    Pre-K
    Professional Development
    Senior high
    Special needs
    Vocational
    Other, please specify:

* What funding has supported the development of your Innovation? (Check all that apply)
    Academic/non-profit institution
    Angel investor
    Venture capital firm
    Corporate/for-profit entity
    Education/private foundation
    Federal agency
    Self/friends and family
    State agency
    Strategic investors
    Other, please specify:

* Describe your organization's innovative products/services in detail (limit to 500 characters)

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Please provide additional details for logging in or accessing your innovation. This information will be provided to our judges. It is crucial that you alert SIIA if log in details change. Contact Liderby Portorreal with changes. (limit to 500 characters)

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Please provide any additional information that you would like us to take into consideration (limit to 500 characters)

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In order to select participants for the Innovation Incubator Program, this information will be shared with the following SIIA education division boards and committees: 2013 SIIA Education Business Forum Steering Committee, Membership Programs Committee, Postsecondary Sector Board, Tech Dev Committee, and Education Division Board of Directors, Ed Board Alumni Group, as well as educators with a significant interest in innovation and technology. If you are selected to participate in the Innovation Incubator Program, some of this information may also be provided to 2013 SIIA Education Business Forum conference attendees.