Please complete ALL sections of the application form as fully as you can.
Please be assured that all information you provide will be treated in the strictest confidence

This application will be used to select candidates for a limited number of interviews. It is in your best interest to provide as much information as possible in each section.

Promoter Details
Name of Promoter(s):
Contact Address:
Telephone/Mobile:
Email:
Business Partner:		(if any)
Partner Address:
Partner Telephone/Mobile:
Partner Email:
Employment History:		Please provide a brief outline of your current and previous employment, including your job title, role and main responsibilities.  (Please attach a CV)
Heard About:		Where did you hear about the Propel – Ideas into Businesses Programme?
The Proposed Business Idea
What sub-sector is your business in?		Life sciences: Biotechnologies Pharmaceuticals Medical devices Diagnostics Medical technologies Other...please clarify below.
Your Business Idea/Value Proposition		Please complete the table below in the greatest detail possible:
Business Idea: Product/Service or both. Please Provide Details Market: What is the target market? E.g. geography, industry sector Customer: Who are the target customers? Customer Issue: What is the key issue for the customer? The Proposition: Uniqueness, Attractiveness? Pricing: How will we price the product? Benefits: What are the benefits for the customer? Reason to Believe: What evidence supports our claims? Key Communications: What should we focus on in our communications for the proposition? Trade offs: What may have to be sacrificed, or underplayed in order to achieve success?
		(Please attach a copy of your business plan if available)
Main tasks:		What are the main tasks and key challenges you face in developing your business? Please list your key milestones over the next 12-18 months:
Location:		Where do you propose locating your business?
Additional Information
		(Please provide any additional information you feel may be relevant)
Are you currently committed to this proposed project full time? Yes No
Are you committed to participating fully in all elements of the Propel – Ideas into Businesses programme? Yes No
Have you (or a proposed business partner) applied for/received government funding for this concept previously? Yes No
Details:		(If yes, please provide details)
		By clicking the Submit button below I certify that the information given in this application is correct.