Improvement of NSF/NIH I-CORPS Longitudinal Outcomes Survey

Appendix C: Question Changes to the Cleared Instrument
[OMB approval number is 3145-0238, expiration date April 30, 2018.]

KEY

blue text
orange text
ID
#

= updated/slight modification from item in time 1
= new item

Lo
gic

Item

R
e

Project Status
This
survey asks about your experiences as a(n) [ROLE]
with the [TEAM NAME] team from [INSTITUTION] i
n the [COURSE NAME] I-­‐
Corps course, the same team you updated us on in
the first I-­‐ Corps Longitudinal Outcomes Survey.

0

Displayed for all

Please note: if you have participate in other I-­‐
Corps teams in addition to the team above, there w
ill be space at the end
of the survey to share your other experiences. Plea
se fill out all other questions for the [TEAM NAME]
team.

Since you last updated us in
2014, have you been involved
with the I-­‐Corps project?
1

2

Displayed for all

If item 1
(involvement with I-­‐
Corps project) response
is "No, I stopped being i
nvolved with the projec
t."

If you continued involvement, please describe how
you were involved the comment box.

If you know who is
the most knowledgeable person to contact about
the project right now, please provide details belo
w.

NA -­‐ display

Yes, I continued to be involved with t
he project No, I stopped being involve
d with the project.

Make a comment on your choice here:
textbox
Name:
Role in project:

35

Business Creation and Dissolution
Business Info
If response to item 8 (new company c
reation) is "one or more companies ha
ve been incorporated"

The I-­‐Corps PI
The I-­‐Corps EL The I-­‐Corps EL
The I-­‐Corps mentor The I-­‐
Corps mentor Equal sharehol

OR
If existing company in VW database (vi
a intake/post responses, news forward
ed from NSF project officer, etc.)

Who is the majority or principal sharehold
er of the company?

ders (please describe) Equal
shareholders (please describe)

Other

Funding Routing
If item 1 (involvement with I-­‐
Corps project) response is "yes, I conti
nued to be involved with the project"

Federal government funding
Did you seek funding for this I-­‐
Corps project from any of the following sourc
es? Please Multiple choice.

State or regional government fundin
g
Non-­‐government funding
I did not seek funding [note that th
is is included to make it possible for
ce an answer to this question]

Government Funding

If "State or regional government fun
ding" is selected in item 43 (types of f
unding sought)

Please enter as much information as you can
about any additional state or regional govern
ment funding you received for your I-­‐
Corps project below.

Date awarded (mm/yyyy)
Amount awarded
State Abbreviation,
if applicable (MA, NY etc.)
Region, if applicable
Description

If "State or regional government fun
ding" is selected in item 43 (types of f
unding sought)

If you received any additional government f
unding not covered above, please explain:

textbox

36

Private Funding
Self investment in the business entity
Bootstrap or crowd-­‐funding Bootstrap or crowd-­‐
funding
Individual private investment from non-­‐
accredited investor(s) (e.g., family, friends, etc.) I

51

If "Non-­‐
government funding" is selected in it
em 43 (types of funding sought)

Did you seek funding or support for t
his I-­‐
Corps project from any of the followin
g sources? Please Multiple choice.

ncubator or accelerator direct financing or
equity exchange
Debt financing (e.g., SBA loan or convertible
debt instrument)
Accredited angel investor or group
Non-­‐corporate institutional venture capital/seed
stage funding
Corporate venture capital/seed stage funding
Funding from foundations and non-­‐
profits Other

If selected "Self investment in the b
usiness entity" in item 51 (types of n
on-­‐ government funding sought)
52

Amount
Please enter as much information as you c
an about your self investment in this I-­‐
Corps project.

Date received (mm/yyyy)
Description/Source (optional)

53

54

If selected "Bootstrap
or crowd-­‐
funding Bootstrap or
crowd-­‐funding" in item
51 (types of non-­‐
government funding sought)

If selected "Individual private invest
ment from non-­‐
accredited investor(s) (e.g.,
family, friends, etc.)" in item 51 (types
of non-­‐ government funding sought)

Amount
Please enter as much information as you c
an about your I-­‐
Corps project's bootstrap orcrowd-­‐
funding activities.

Date received (mm/yyyy)

Description/Source (optional)

Amount
Please enter as much information as you c
an about your I-­‐
Corps project's funding from individual priv
ate investment from non-­‐
accredited investors.

Date received (mm/yyyy)

Description/Source (optional)

37

If selected "Incubator or accelerator direct financing or equit
100
Ventu y exchange" in item 51 (types of non-­‐
re
government funding sought)
Way,
Hadle
y MA
2172
|
www.
t
If selected "Debt financing (e.g., SBA loan or convertible debt
instrument)" in item 51 (types of non-­‐
government funding sought)
56

Please enter as much information as you can about
your I-­‐
Corps project's funding from incubator or accelerat
or direct financing or equity exchange.

Amount
Date received (
mm/yyyy)

Description/Sour
ce (optional)
Amount
Please enter as much information as you can abou
t your I-­‐
Corps project's funding from debt financing.

Date received (
mm/yyyy)

Description/Sour
ce (optional)
If selected "Accredited angel investor or group" in item 51 (typ
es of non-­‐ government funding sought)
57

Please enter as much information as you can about
your I-­‐
Corps project's funding from accredited angel inves
tors or groups.

Amount
Date received (
mm/yyyy)
Description/Sour
ce (optional)

58

If selected "Non-­‐
corporate institutional venture capital/seed stage funding" in i
tem
51 (types of non-­‐ government funding sought)

Amount
Please enter as much information as you can abou
t your I-­‐
Corps project's funding from venture capital and/o
r seed stage sources.

Date received (
mm/yyyy)

Description/Sour
ce (optional)
If selected "Corporate venture capital/seed stage funding " in i
tem
51 (types of non-­‐ government funding sought)
59

Please enter as much information as you can about
your I-­‐
Corps project's funding from venture capital and/or
seed stage sources.

Amount
Date received (
mm/yyyy)
Description/Sour
ce (optional)

If selected "Funding from foundations and non-­‐
profits" in item 51 (types of non-­‐ government funding sought)
60

Please enter as much information as you can abou
t your I-­‐
Corps project's funding from venture capital and/o
r seed stage sources.

Amount
Date received (
mm/yyyy)
Description/Sour
ce (optional)

2172

38

Planned Funding

61

If item 1 (involvement with I-­‐
Corps project) response is "yes, I co
ntinued to be involved with the proj
ect"

Will you seek funding for this I-­‐
Corps project from any of the following sour
ces in the next 12 months? Please Multiple
choice.

Federal government funding
State or regional government funding
Non-­‐g overnment funding
I will not seek funding [note that this included in
order to force a response for this question]
Small Business Innovation Research (SBIR)
Phase I Small Business Innovation Research
(SBIR) Phase I
Small Business Innovation Research (SBIR)
Phase II
Small Business Technology Transfer Program (
STTR) Phase I

62

If "Federal government funding" is s
elected in item 61 (types of funding y
ou will seek)

Which NSF awards, if any, will you apply for
based on your I-­‐
Corps project in the next 12 months? Multip
le choice.

Small Business Technology Transfer Program (
STTR) Phase II
Accelerating Innovation Research/Partnerships
for Innovation (AI
R/PFI)
Engineering Research Center (ER
C)
Grant Opportunities for Academic Liaison with I
ndustry (GOALI)
Science and Technology Centers (STC
)

Department of Agriculture
Department of Commerce
Department of Defense
Department of Education
Department of Energy

63

If "Federal government funding" is s
elected in item 61 (types of funding y
ou will seek)

Which other agencies, if any, will you apply t
o for SBIR/STTR awards based on your I-­‐
Corps project in the next 12
months? Multiple choice.

Department of Health and Human S
ervices/National Institutes of Health
Department of Homeland Security
Department of Transportation
Environmental Protection Agency
National Aeronautics and Space Administration
National Institute of Standards and Technology
National Oceanic and Atmospher
ic Administration

39

Self investment in the business ent
ity
Bootstrap or crowd-­‐
funding Bootstrap or
crowd-­‐funding

64

If " Non-­‐
government funding" is selected in item 61 (types of fu
nding you will seek)

Will you seek funding or support for this I-­‐
Corps project from any of the following so
urces in the next
12 months? Please Multiple
choice.

Individual private investment from
non-­‐
accredited investor(s) (e.g., family,
friends, etc.)
Incubator or accelerator direct fin
ancing or
equity exchange
Debt financing (e.g., SBA loan or c
onvertible
debt instrument)
Accredited angel investor or group
Non-­‐
corporate institutional venture
capital/seed stage funding

Incubator or Accelerator Support

Corporate venture capital/seed st

If item 1 (involvement with I-­‐
Corps project) response is "yes, I continued to be involv
ed with the project"
AND

65

Item 3 (whether project is active) response is "Y
es"

If response to Item 65 (non-­‐
financial incubator or accelerator support) is "yes"
66

Has your I-­‐
Corps project participated in or received
non-­‐
financial incubator or accelerator supp
ort?

Please list the incubators or accelerators
your I-­‐
Corps project has been affiliated with.

Binary: Y/N

Name
Dates affiliated
Description

If response to Item 65 (non-­‐
financial incubator or accelerator support) is "yes"
6
7

Physical office space
Please check the types of support your I-­‐
Corps project has received from incubators
or accelerators.

Wet labs/bench space
Training and/or mentorship
Access to investment network(s)
Other:

40

100
Ventur If item 1 (involvement with I-­‐
e Way, Corps project) response is "yes, I conti
Hadley nued to be involved with the project"
MA
AND
68

69

70

Item 3 (whether project is acti
ve) response is "No"

If response to item 68 (past non-­‐
financial incubator or accelerator supp
ort) is "Yes"

If response to item 69 (past non-­‐
financial incubator or accelerator supp
ort) is "Yes"

Did your I-­‐
Corps project participate in or recei
ve non-­‐
financial incubator or accelerator s
upport?

Binary: Y/N

Name
Please list the incubators or accele
rators your I-­‐
Corps project was affiliated with.

Dates affiliated
Description

Physical office space Wet l
Please check the types of support y
our I-­‐
Corps project received from incuba
tors or accelerators.

abs/bench space Training a
nd/or mentorship
Access to investment network(s)
Other:

Sales of new products, Services, or Processes

Licensing

New Venture

77

All who consented to
survey see this

Many participants who have comple
ted the I-­‐
Corps course have gone on to form n
ew ventures unrelated to their I-­‐
Corps projects.

Binary: Y/N

Are you currently pursuing a
new venture?

78

If response to item 77 (new venture)
is "Yes"

What is the name of this new
venture?

textbox

41

79

If response to item 77 (new vent
ure) is "Yes"

80

If response to item 77 (new vent
ure) is "Yes"

Are you using Osterwalder's Business Model Canvas in your ne
w venture?

Binary: Y/N

Are you using the customer discovery process in your new ventur
e?

Binary: Y/N

Other Outcomes

84

All who consented to
survey see this

Did the I-­‐
Corps award lead to any collaborations between you and the ext
ernal community?

Industry
Investors
Local or state government
Non-­‐profit organization
Other

85

If response is "Yes "for "Other" in
item 84 (individual collaborations)

86

If response is "Yes "for "Industry"
in item 84 (individual collaboratio
ns)

87

If response is "Yes "for "Industry"
in item 82 (individual collaboratio
ns)

Please identify any other collaborations between you and the ex
ternal community.

textbox

Please describe your industry
collaboration(s).

textbox

What do you gain from your
collaborations with industry?

Opportunities to advance the co
mmercialization of your researc
h
Opportunities to advance your
research agenda
Neither of the above

88

89

All who consented to
survey see this

If response is "Yes" for item 86 (u
niversity collaborations)

Did the I-­‐
Corps award lead to any collaborations between the university y
ou are currently affiliated with and the external community?

Which of the following collaborations between the university you
are currently affiliated with and the external community did the
I-­‐ Corps award lead to?

Yes
No
I am no longer
affiliated with a university

Industry
Investors
Local or state government
Non-­‐profit organization
Other

90

If response is "Yes" for "Other" in
item 89 (types of university collab
orations)

Please identify any other collaborations between your university
and the external community.

Textbox

42

Opportunities
Customer interviews

91

All who consented to
survey see this

Which, if any, of the following did you personall
y experience as a result of your interactions duri
ng the [COURSE YEAR, SEASON, AND NODE] I-­‐
Corps course? Multiple choice

Instructor engagements
Interactions with your team's EL(s) or PI(s)
Interactions with your team's mentor(s)
Interactions with other teams' ELs or PIs Interact
ions with other teams' mentors Other interactio
ns

92

All who consented to
survey see this

Please describe:

textbox
Customer interviews

93

All who consented to
survey see this

Which, if any, of the following did your team re
ceive as a result of interactions during the [COU
RSE YEAR, SEASON, AND NODE] I-­‐
Corps course? Multiple choice.

Instructor engagements
Interactions with your team's EL(s) or PI(s)
Interactions with your team's mentor(s)
Interactions with other teams' ELs or PIs
Interactions with other teams' mentors
Other interactions

94

All who consented to
survey see this

Please describe:

textbox
Current Employment

95

96

All who consented to
survey see this

Do you currently work for a
college or university?

If response to item 95
(whether currently wor
king for college or univ
ersity) is "Yes"

Do you currently work for [PERSONAL INSTIT
UTION AT REGISTRATION]?

Yes
No
Not currently employed
Yes
No -­‐ please enter current institution name:

43

Tenured faculty member
Faculty member on track for Tenure
and Promotion
Non-­‐tenured Faculty

97

If response to item 95 (whether currentl
y working for college or university) is "Yes
"

Which of the following best describes
your current role? Multiple choice.

Nontraditional university appointment (e.g., Pr
ofessor of Practice, Visiting Scholar, etc.)
Research scientist
University Leader (Dean, Provost, etc.) Admi
nistrative Staff (Academic Advisor, Center
Director, etc.)
Student
Other:

Agriculture
Education
Energy & Materials
If response to item 95 (whether currentl
y working for college or university) is "No"
98

Environment
Which of the following best describes yo
ur current employer’s primary industry?

Healthcare/Medical
Information Technology and Communicati
ons
Infrastructure/Building
Sanitation/Water
Not applicable
Other
1-­‐10 employees
11-­‐50 employees

99

If response to item 95 (whether currentl
y working for college or university) is "No"

Which of the following best describes
your current employer’s company size
?

51-­‐200 employees
201-­‐500 employees
501-­‐1000 employees
More than 1000 employees
Other

100

If response to item 95 (whether currentl
y working for college or university) is "No"
or "Yes"

Did your work in I-­‐C orps lead
to your current employment?

Yes
No
Unsure

100 Venture Way, Hadley MA 413 587 2172 | www.venturewell.org

44

If response to item 100 (work in I-­‐Corps
leading to current employment) is "Yes" or "Unsure"
101

102

If response to item 95 (whether currently working for c
ollege or university) is "No" or "Yes"
(that is, if respondent indicated that they are employe
d)

Please explain:

textbox

In what ways, if any has I-­‐ Corps influenced your career?

textbox

Other I-­‐Corps Experiences
Have you participated in another national I-­‐
Corps team in addition to [TEAM NAME]?

103

All who consented to
survey see this

104

Please share some information on the other team(s) you have partici
If response to item 103 (other national team participat pated in.
ion) is "Yes"

Binary: yes/no

Team name(s)
Team company(i
es)
Which course(s)
attended
textbox

105

Did
If response to item 103 (other national team participat the team(s) raise any government funding? Please describe, including f
ion) is "Yes"
unding type (SBIR, PFI:AIR TT, etc.)

106

If response to item 103 (other national team participat
ion) is "Yes"

textbox

Did the team(s) raise any private funding? Please describe.

45