NSF I-Corps Longitudinal Survey Instrument Time 2

Appendix B: NSF I-Corps Longitudinal Survey Instrument
Time 2

29

Omnibus
Instrument
Item #
11

Item
Count
1

I-Corps
only

12

2

I-Corps
only

12.1

3

NSF ICorps
Mentors
Only

12.2

4

NSF ICorps
Mentors
Only

13

5

All

16

6

All

17

7

All

Project Status
Since you last updated us in 2014, have you been involved with the I-Corps project?
If you continued involvement, please describe how you were involved in the comment
box.
•
Yes, I continued to be involved with the project
•
No, I stopped being involved with the project.
Make a comment on your choice here:
[If item 1 (involvement with I-Corps project) response is "No, I stopped being involved
with the project."]
If you know who is the most knowledgeable person to contact about the project right
now, please provide details below.
Name:____________
Role in project:____________
[If item 1 (involvement with I-Corps project) response is “Yes, I continued to be involved
with the project”] Please indicate what type of involvement, if any, you still have with the
above I-Corps team.
•
I am no longer involved at all.
•
I still act as mentor (including casual phone calls, emails, etc.)
•
I am an advisor sharing specific expertise (e.g., legal advice) with the team or
company
•
I am an investor or shareholder in the related company
•
I serve on the board of directors of the related company
•
I am on the management team of the related company (e.g., CEO or CFO)
[If item 1 (involvement with I-Corps project) response is “Yes, I continued to be involved
with the project” and Item 3 (level of mentor involvement) is anything except for “I am no
longer involved at all”] In your current role, can you provide specific details about the
team's project status (e.g., when a company was formed or whether there are any
product sales)?
•
Yes
•
No
Is this project still active?
•
Yes [go to item 9]
•
No [go to item 7]
•
Uncertain
[If item 5 (whether project is active) response is "Uncertain"]
Select any of the reasons listed below that explain why you are uncertain.
•
We have not yet identified a large enough market for our product/technology
•
The time to get the technology into market may be too great
•
We are encountering difficulties with our technology itself
•
We have not yet obtained needed financing/investment to continue
•
We are having problems with intellectual property
•
We are having problems with our team
•
Other (specify)
[If item 5 (whether project is active) response is "No"]
Why is this project no longer active?
•
We successfully commercialized our project
•
We decided to discontinue pursuing commercialization for our project
•
Other (Specify)

30

17.1

8

All

18

9

All

18.1

10

All

[If item 6 (reasons project is not active) response is "We decided to discontinue
commercialization for our project"]
Did you decide to discontinue pursuing commercialization for your project for any of the
following reasons? [check all that apply]
•
We were not able to identify a large enough market for our product/technology
•
The time to get the technology into market was too great
•
We had problems with our intellectual property
•
We encountered difficulties with the technology or product
•
We could not obtain necessary financing/ investment to continue
•
The company was acquired
•
We had problems with our team
Which of the following best describes your project's current area of research or
technology?
•
Advanced Materials and Instrumentation (MI)
•
Advanced Manufacturing and Nanotechnology (MN)
•
Biological Technologies (BT)
•
Chemical and Environmental Technologies (CT)
•
Electronic Hardware, Robotics and Wireless Technologies (EW)
•
Internet of Things (I)
•
Educational Technologies and Applications (EA)
•
Information and Communication Technologies (IC)
•
Semiconductors (S) and Photonic (PH) Devices and Materials
•
Smart Health (SH) and Biomedical Technologies (BM)
•
Other: Please Specify
[If item 9 (tech clusters) response is "Smart Heath (SH) and Biomedical Technologies
(BM)"]
Please specify:
• Electronic health/education tools
•
Life sciences research tools
•
Medical devices (including medical imaging devices and innovative materials to
construct new devices)
•
Medical diagnostics
•
Therapeutics (including small molecules, biologics, and imaging agents)
•
Other
Business Creation or Dissolution

23

11

All

[If no company in VW database (via intake/post responses, news forwarded from NSF
project officer, etc.)]
Our records indicate that no company has been incorporated based on your I-Corps
project. Is this still correct?
•
No company has been incorporated
•
One or more companies have been incorporated

31

24

12

I-Corps
only

We have the following company information associated with your team.
Company Name: [COMPANY NAME FROM VW DATABASE]
Incorporation date: [COMPANY INCORPORATION DATE FROM VW DATABASE]
Current status: [ACQUIRED OR ACTIVE - Time 1 and VW COMPANY DATABASE]
Website: [COMPANY WEBSITE FROM VW DATABASE]
If any information needs to be updated, please check all that apply.
If existing company in VW database (via intake/post responses, news forwarded from NSF
project officer, etc.)
•
Name is incorrect
•
Incorporation date is incorrect or needs to be added
•
Website is incorrect or needs to be added
[if yes to 11] What is the name of this company? If you are unsure, please type "unsure."
Please note that if there are multiple companies, we ask that you respond only for the
company that was active most recently.
Text: open

26

13

All

27

14

All

[if yes to item 11] What is the URL of the company's website, if any?

28

15

All

[if yes to item 23 or 25] When was the company incorporated? (mm/dd/yyyy)

29

16

All

30

17

All

31

18

All

32

19

All

[if yes to item 11] Is this company still operational?
•
Yes
•
No
[ if yes to item 11] What sector best describes this company?
•
Agriculture
•
Education
•
Energy & Materials
•
Environment
•
Healthcare/Medical
•
Information Technology and Communication
•
Infrastructure/Building
•
Sanitation/Water
•
Other (specify)
[If response to item 16 (whether company is operational) is "No"]
Why did the company close/dissolve?
[Check all that apply]
•
We were not able to identify a large enough market for our product/technology
•
The time to get the technology into market was too great
•
We had problems with our intellectual property
•
We encountered difficulties with the technology or product
•
We could not obtain necessary financing/investment to continue
•
The company was acquired
•
Other (specify)
[If response to item 16 (whether company is operational) is "No"]
Approximately when did this company close or dissolve?
(mm/yyyy)

32

33

20

I-Corps
only

34

21

I-Corps
only

35

22

I-Corps
only

36

23

I-Corps
only

[If response to item 11 (new company creation) is "one or more companies have been
incorporated" OR If response to item 12 (whether Time 1 response needs to be updated)
is "Yes"]
Which of the following best describes how the business was started.
•
A new business, branch or subsidiary owned by an existing business
•
A business inherited from someone else
•
A new, Independent business created by a single person or a team of people
•
The purchase of an existing business
•
The purchase of a franchise
•
An organization designed for social and charitable objectives and legally
established as a not-for-profit
•
Other (specify)
[If existing company in VW database (via intake/post responses, news forwarded from
NSF project officer, etc.) AND Time 1 response to this question.]
In 2014, you told us that:
The business was started as [STARTING BUSINESS FORM AT Time 1].
The business's current legal form is a(n) [CURRENT BUSINESS FORM AT Time 1].
If it had another legal form, the business was previously a(n) [OTHER LEGAL FORM AT
Time 1].
Is this still correct? *
•
Yes
•
No
[If response to item 11 (new company creation) is "one or more companies have been
incorporated"OR If response to item 12 (whether Time 1 company info is correct) is "No"]
Which form of legal status does your business currently have?
•
Sole Proprietorship: A type of business ownership in which a business is owned
and managed by one individual and no sub-chapter S-corporation or Ccorporation has been established.
•
Limited Liability Company: A cross between a corporation and a partnership,
and offering some of the benefits of both. Similar to S corporations, income
produced by a limited liability company flows through the owners (known as
“members”) who pay their own taxes as individuals. Unlike S corporations,
however, limited liability companies are not subject to as many government
restrictions.
•
Sub-chapter S-Corporation: Corporations in which all profits and losses are
passed through to shareholders, just as they are passed through to legal
partners in a partnership.
•
C-Corporation: Legal entities separate from their owners that may engage in
business, make contracts, own property, pay taxes, and sue and be sued by
others.
•
General Partnership: An association of two or more people who co-own a
business for the purpose of making a profit and no sub-chapter S-corporation or
C-Corporation has been established.
•
Limited Partnership: A partnership in which one or more partners who manage
the business and others are limited partners who invest in the business but
forgo any right to manage the company.
•
Other (specify)
[If response to item 11 (new company creation) is "one or more companies have been
incorporated" OR If response to item 12 (whether Time 1 company info is correct) is "No"]
Since you incorporated, were the business operations ever conducted under one of the
other legal forms listed above?
•
Yes
•
No

33

37

24

I-Corps
only

37.1

25

I-Corps
@ NIH
only

[If response to item 11 (new company creation) is "one or more companies have been
incorporated"ORIf response to item 12 (whether Time 1 company info is correct) is "No"]
Which form of legal status did the business previously have?
•
Sole Proprietorship: A type of business ownership in which a business is owned
and managed by one individual and no sub-chapter S-corporation or Ccorporation has been established.
•
Limited Liability Company: A cross between a corporation and a partnership,
and offering some of the benefits of both. Similar to S corporations, income
produced by a limited liability company flows through the owners (known as
“members”) who pay their own taxes as individuals. Unlike S corporations,
however, limited liability companies are not subject to as many government
restrictions.
•
Sub-chapter S-Corporation: Corporations in which all profits and losses are
passed through to shareholders, just as they are passed through to legal
partners in a partnership.
•
C-Corporation: Legal entities separate from their owners that may engage in
business, make contracts, own property, pay taxes, and sue and be sued by
others.
•
General Partnership: An association of two or more people who co-own a
business for the purpose of making a profit and no sub-chapter S-corporation or
C-Corporation has been established.
•
Limited Partnership: A partnership in which one or more partners who manage
the business and others are limited partners who invest in the business but
forgo any right to manage the company.
•
Other (specify)
[Item 3 (whether project is active) response is "Yes"]
Please select the items below that are true of your business.

Women are …
Socially disadvantaged individuals
are …

37.2

26

I-Corps
@ NIH
only

majority
owner(s)
□
□

co-owner(s)
□
□

in leadership
role(s)
□
□

Help text: The SBA defines socially disadvantaged individuals as "those who have been
subjected to racial or ethnic prejudice or cultural bias because of their identity as a
member of a group without regard to their individual qualities."
["If response to item 16 (whether company is active) is "yes"]
Does your business meet the requirements for 8(a) certification?
•
Yes, and we are 8(a) certified
•
Yes, and our 8(a) application is in process
•
Yes, and we intend to apply for 8(a) certification
•
Yes, and we do not intend to apply for 8(a) certification
•
No, we do not meet the requirements
•
Unsure
Business Information

34

38

27

I-Corps
only

39

28

All

40

29

I-Corps
Only

41

30

I-Corps
Only

42

31

I-Corps
Only

43

32

I-Corps
Only

[If existing company in VW database (via intake/post responses, news forwarded from
NSF project officer, etc.) AND Time 1 responses to this group of questions. If more than
one company, showing active one only]
We have the following CEO information for [COMPANY NAME FROM VW DATABASE]:
Role on I-Corps team: [Time 1 RESPONSE]
Industry type, if not from I-Corps team: [Time 1 RESPONSE]
Is this still correct?
•
Yes
•
No
[If response to item 11 (new company creation) is "one or more companies have been
incorporated" OR “no” for non-I-Corps OR If response to item 38 (whether Time 1 CEO
info is correct) is "No"]
Who is the CEO of your company? If you would like to explain your answer further, please
use the comment box.
•
The I-Corps PI
•
The I-Corps EL
•
The I-Corps Mentor
•
Other (specify)
[If response to item 28 (CEO of company) was "Other"]
Please indicate what industry or type of business the CEO is from.
Text box
[If response to item 11 (new company creation) is "one or more companies have been
incorporated" OR If existing company in VW database (via intake/post responses, news
forwarded from NSF project officer, etc.)]
Which companies do you consider to be your major competitors and why?
Text box
["If response to item 11 (new company creation) is "one or more companies have been
incorporated" OR If existing company in VW database (via intake/post responses, news
forwarded from NSF project officer, etc.)]
What sector best describes the industry of your major competitors?
•
Agriculture
•
Education
•
Energy & Materials
•
Environment
•
Healthcare/Medical
•
Information Technology and Communication
•
Infrastructure/Building
•
Sanitation/Water
•
Other (specify)
[If response to item 11 (new company creation) is "one or more companies have been
incorporated" OR If existing company in VW database (via intake/post responses, news
forwarded from NSF project officer, etc.)]
Which company size best describes your major competitors?
•
1-10 employees
•
11-50 employees
•
51-200 employees
•
201-500 employees
•
501-1000 employees
•
More than 1000 employees
•
Other (specify)

35

46

33

I-Corps
only

47

34

I-Corps
only

If response to item 11 (new company creation) is "one or more companies have been
incorporated"ORIf existing company in VW database (via intake/post responses, news
forwarded from NSF project officer, etc.)]
Who is the majority or principal shareholder of the company?
•
The I-Corps PI
•
The I-Corps EL
•
The I-Corps mentor
•
Equal shareholders (please describe)
•
Other (specify)
[If existing company in VW database (via intake/post responses, news forwarded from
NSF project officer, etc.) AND Time 1 responses to this set of items]
In 2014, you told us that [COMPANY NAME FROM VW DATABASE] had the following:
[Time 1 RESPONSE] Individuals or entities who owned shares in the business
[Time 1 RESPONSE] owner(s) who actively helped run the business
[Time 1 RESPONSE] full time employees
[Time 1 RESPONSE] part time employees

48

35

I-Corps
only

49

36

I-Corps
only

Is this information still correct?
•
Yes
•
No
[If response to item 11 (new company creation) is "one or more companies have been
incorporated" OR If response to item 47 (whether Time 1 ownership and employees
responses are still correct) is "No"]
Since participation in I-Corps, how many individuals or entities owned shares in the
business?
[If response to item 11 (new company creation) is "one or more companies have been
incorporated"ORIf response to item 28 (whether Time 1 ownership and employees
responses are still correct) is "No"]
Of the owner or owners since participation in I-Corps, how many owners actively helped
to run the business?
Textbox

50

37

50.1

38

50.2

39

By “helped to run the business” we mean that they provided regular assistance or advice
with day-to-day operations of the business, rather than providing only money or
occasional operating assistance.
["If response to item 29 (whether company is active) is "yes"]
Not counting owner(s), approximately how many people currently work for the business?
•
Full time employees***
•
Part time employees
*** Full time: working 35 hours or more per week.
["If response to item 29 (whether company is active) is "yes"] Do you or your employees
draw a salary from your business?
•
Yes
•
No
[If response to item 38(whether anyone draws a salary) is “yes”] Please estimate the
average salary of all employees of your business. Include yourself or any other owners in
your estimate.
Textbox
For example, if there are 3 employees, and their individual salaries are $10,000, $20,000
and $30,000, the average salary of all employees is $20,000.

36

Engaged in Licensing
51

40

I-Corps
Only

[If item 1 (involvement with I-Corps project) response is "yes, I continued to be involved
with the project" AND If response to item 34 (whether Time 1 ownership and employees
responses are still correct) is "No"]
After the I-Corps course ended, did you engage in any licensing activities?
•
Yes
•
No
Licensing Activities

52

53

41

42

I-Corps
Only

[If Time 1 response] In 2014, you told us that [XXX] employee(s) worked in areas related to
product development or other activities arising from your I-Corps participation.

I-Corps
Only

Is that still correct?
•
Yes
•
No
[If response to item 40 (licensing activities) is "Yes" OR If response to item 52 (whether
Time 1 employees in product development is still correct) is "No"]
How many employees work in areas related to product development or other activity
arising from your I-Corps participation?

54

55

43

44

I-Corps
Only

All

[Textbox]
[If Time 1 response]
In 2014, you told us that your business had:
[Time 1 response] invention(s) disclosed
[Time 1 response] patent application(s)
[Time 1 response] patent(s) granted
[Time 1 response] patent(s) in use
[Time 1 response] invention(s) producing royalties
[Time 1 response] software copyright(s)
[Time 1 response] company trademark(s)
[Time 1 response]} non-disclosure agreement(s) (NDA)
[Time 1 response] materials transfer agreement(s) (MTA)
Are these totals still correct?
•
Yes
•
No
How many of the following does the business have? Enter "0" if none.
•
Inventions Disclosed ________
•
Licensing Agreements ________
•
Patent Applications ________
•
Patents Granted ________
•
Patents in Use ________
•
Inventions Producing Royalties ________
•
Software Copyrights ________
•
Company Trademarks ________
•
Non-disclosure Agreements (NDA) ________
•
Materials Transfer Agreements (MTA) ________

37

56

45

I-Corps
Only

[If Time 1 response]
In 2014, you told us that your business had the following licensed out** since
participating in I-Corps:
[Time 1 response] patents
[Time 1 response] copyrights
[Time 1 response] trademarks
Are these totals still correct?
•
Yes
•
No

57

46

I-Corps
Only

*** Licensing out is licensing patents, copyrights, or trademarks owned by the business to
other parties under a licensing agreement.
[If response to item 11 (licensing activities) is "Yes" OR If response to item 45 (if Time 1
licensing correct) is "No"]
In 2014, you told us that your business had the following licensed in** since participating
in I-Corps:
{TOKEN:ATTRIBUTE_42} patents
{TOKEN:ATTRIBUTE_32} copyrights
{TOKEN:ATTRIBUTE_33} trademarks
Are these totals still correct?
•
Yes
•
No

58

47

All

**Licensing in is acquiring the right to use intellectual property such as patents,
copyrights, or trademarks created by someone outside the business through a licensing
agreement.
How many patents, copyrights, or trademarks has the business licensed out ** since your
participation in I-Corps. Enter "0" if none.
Licensed OUT**
Patents
Copyrights
Trademarks
Trade Secrets
** Licensing out is licensing patents, copyrights, or trademarks owned by the business to
other parties under a licensing agreement.

58.1.

48

All

How many patents, copyrights, or trademarks has the business licensed in *** since your
participation in I-Corps. Enter "0" if none.

Patents
Copyrights
Trademarks
Trade Secrets

Licensed IN**

*** Licensing in is acquiring the right to use intellectual property such as patents,
copyrights, or trademarks created by someone outside the business through a licensing
agreement.
Funding Routing

38

59

49

All

Did you seek funding for your NSF project from any of the following sources? Please check
all that apply?
•
Federal government funding
•
State or regional government funding
•
Non-government funding
•
I did not seek funding
Federal Funding

60

50

All

[If “Federal government funding” is selected in item 49 (types of funding sought)]
Did you apply for government funding from any of the following agencies? (Check all that
apply)

61

51

All

Yes
No
National Science Foundation
□
□
Department of Agriculture
□
□
Department of Commerce
□
□
Department of Defense
□
□
Department of Education
□
□
Department of Energy
□
□
Department of Health and Human Services
□
□
Department of Homeland Security
□
□
Department of Transportation
□
□
Environmental Protection Agency
□
□
National Aeronautics and Space Administration
□
□
National Institute of Standards and Technology
□
□
National Oceanic and Atmospheric
□
□
Administration
[If “Federal government funding” is selected in item 49 (types of funding sought)]
Did you receive government funding from any of the following agencies? (Check all that
apply)

National Science Foundation
Department of Agriculture
Department of Commerce
Department of Defense
Department of Education
Department of Energy
Department of Health and Human Services
Department of Homeland Security
Department of Transportation
Environmental Protection Agency
National Aeronautics and Space Administration
National Institute of Standards and Technology
National Oceanic and Atmospheric
Administration
State and Regional Funding

Yes
□
□
□
□
□
□
□
□
□
□
□
□
□

No
□
□
□
□
□
□
□
□
□
□
□
□
□

39

62

52

All

[If "State or regional government funding" is selected in item 49 (types of funding sought)]
Please enter as much information as you can about any additional state or regional
government funding you received for your I-Corps project below.
Date
awarded
(mm/yyyy)

Amount
awarded

State
Abbreviation,
if applicable
(MA, NY etc.)

Regional
funding, if
applicable

Description

Additional
Government
Funding 1
Additional
Government
Funding 2
Additional
Government
Funding 3
Additional
Government
Funding 4
Additional
Government
Funding 5
Additional
Government
Funding 6

63

53

All

[If "State or regional government funding" is selected in item 49 (types of funding sought)]
Have you received any additional government funding not covered Under Federal funding
or State/regional funding above:
•
Yes
•
No
Please explain:
Private Funding

64

54

All

[If "Non-government funding" is selected in item 49 (types of funding sought)]
Did you seek funding or support for this NSF project from any of the following nongovernment sources?
•
Self-investment in the business entity
•
Bootstrap or crowd-funding
•
Individual private investment from non-accredited investor(s) (e.g., family,
friends, etc.)
•
Incubator 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 (specify)

40

65

55

I-Corps
Only

66

56

I-Corps
Only

67

57

I-Corps
Only

68

58

I-Corps
Only

[If selected "Self investment in the business entity" in item 54 (types of non-government
funding sought)]
Please enter as much information as you can about your self-investment in this I-Corps
project.
Amount
Date received
Description/Source
(mm/yyyy)
(optional)
1.
2.
3.
4.
5.
6.
[If selected "Bootstrap or crowd-funding " in item 54 (types of non-government funding
sought)]
Please enter as much information as you can about your I-Corps project's bootstrap or
crowd-funding activities.
Amount
Date received
Description/Source
(mm/yyyy)
(optional)
1.
2.
3.
4.
5.
6.
[If selected "Individual private investment from non-accredited investor(s) (e.g., family,
friends, etc.)" in item 54 (types of non-government funding sought)]
Please enter as much information as you can about your I-Corps project's funding from
individual private investment from non-accredited investors.
Amount
Date received
Description/Source
(mm/yyyy)
(optional)
1.
2.
3.
4.
5.
6.
[If selected "Incubator or accelerator direct financing or equity exchange" in item 54
(types of non-government funding sought)]
Please enter as much information as you can about your I-Corps project's funding from
incubator or accelerator direct financing or equity exchange.
Amount
Date received
Description/Source
(mm/yyyy)
(optional)
1.
2.
3.
4.
5.
6.

41

69

59

I-Corps
Only

70

60

I-Corps
Only

71

61

I-Corps
Only

72

62

I-Corps
Only

[If selected "Debt financing (e.g., SBA loan or convertible debt instrument)" in item 54
(types of non-government funding sought)]
Please enter as much information as you can about your I-Corps project's funding from
debt financing.
Amount
Date received
Description/Source
(mm/yyyy)
(optional)
1.
2.
3.
4.
5.
6.
[If selected "Accredited angel investor or group" in item 49 (types of non-government
funding sought)]
Please enter as much information as you can about your I-Corps project's funding from
accredited angel investors or groups.
Amount
Date received
Description/Source
(mm/yyyy)
(optional)
1.
2.
3.
4.
5.
6.
[If selected "Corporate venture capital/seed stage funding" in item 49 (types of nongovernment funding sought)]
Please enter as much information as you can about your I-Corps project's funding from
corporate venture capital and/or seed stage sources.
Amount
Date received
Description/Source
(mm/yyyy)
(optional)
1.
2.
3.
4.
5.
6.
[If selected "Corporate venture capital/seed stage funding " in item 49 (types of nongovernment funding sought)]
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
Description/Source
(mm/yyyy)
(optional)
1.
2.
3.
4.
5.
6.

42

73

63

I-Corps
Only

[If selected "Funding from foundations and non-profits" in item 49 (types of nongovernment funding sought)]
Please enter as much information as you can about your I-Corps project's funding from
foundations and non-profits.
Amount
Date received
Description/Source
(mm/yyyy)
(optional)
1.
2.
3.
4.
5.
6.
Planned funding

74

64

I-Corps
Only

[If item 1(involvement with I-Corps project) response is "yes, I continued to be involved
with the project"]
Will you seek funding for this I-Corps project from any of the following sources in the next
12 months?
•
Federal government funding
•
State or regional government funding
•
Non-government funding
•
I will not seek funding
Planned Government Funding

75

65

I-Corps
Only

76

66

I-Corps
Only

[If "Federal government funding" is selected in item 64 (types of funding you will seek)]
Which NSF awards, if any, will you apply for based on your I-Corps project in the next 12
months?
•
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
•
Small Business Technology Transfer Program (STTR) Phase II
•
Accelerating Innovation Research/Partnerships for Innovation (AIR/PFI)
•
Engineering Research Center (ERC)
•
Grant Opportunities for Academic Liaison with Industry (GOALI)
•
Science and Technology Centers (STC)
[If "Federal government funding" is selected in item 64 (types of funding you will seek)]
Which other agencies, if any, will you apply to for SBIR/STTR awards based on your I-Corps
project in the next 12 months?
•
Department of Agriculture
•
Department of Commerce
•
Department of Defense
•
Department of Education
•
Department of Energy
•
Department of Health and Human Services/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 Atmospheric Administration
Planned Private Funding

43

77

67

I-Corps
Only

[If " Non-government funding" is selected in item 64 (types of funding you will seek)]
Will you seek funding or support for this I-Corps project from any of the following sources
in the next 12 months?
•
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.)
•
Incubator 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 (specify)
Incubator or Accelerator Support

78

68

All

79

69

I-Corps
Only

80

70

81

71

Has your NSF project participated in or received non-financial incubator or accelerator
support?
•
Yes
•
No [go to item 84]
[If response to Item 68 (non-financial incubator or accelerator support) is "yes"]
Please list the incubators or accelerators your I-Corps project has been affiliated with.
Name
Dates affiliated
Description
1.
2.
3.
4.
5.
6.
Please check the types of support your NSF project has received from incubators or
accelerators.
•
Physical office space
•
Wet labs/bench space
•
Training and/or mentorship
•
Access to investment network(s)
•
Other (specify):
Past Incubator or Accelerator Support

I-Corps
Only

[If item 1 (involvement with I-Corps project) response is "yes, I continued to be involved
with the project" AND Item 3 (whether project is active) response is "No"]
Did your I-Corps project participate in or receive non-financial incubator or accelerator
support?
•
Yes
•
No

44

82

72

I-Corps
Only

83

73

I-Corps
Only

84

74

All

85

75

All (nonI-Corps
only
items
with
***)

[If response to item 68 (past non-financial incubator or accelerator support) is "Yes"]
Please list the incubators or accelerators your I-Corps project was affiliated with.
Name
Dates affiliated
Description
1.
2.
3.
4.
5.
6.
[If response to item 68 (past non-financial incubator or accelerator support) is "Yes"]
Please check the types of support your I-Corps project received from incubators or
accelerators.
•
Physical office space
•
Wet labs/bench space
•
Training and/or mentorship
•
Access to investment network(s)
•
Other (specify):
Sales of new products, Services, or Processes
Are there any products, services, or processes in the market, market ready, or awaiting
regulatory approval whose commercialization you can attribute (to some degree) to your
NSF project?
•
Yes
•
No [go to item 77]
[If response to item 74 (commercialization) Is "Yes"]
Please enter the following information about these products, services or processes.

Description

Status
(idea/concept,
prototype, ready
for sale, or
selling to
customers)

Number of
units sold (if
any)

Amount of
sales in last
fiscal year

Amount of sales
since
commercialization

1.
2.
3.
4.
5.
6

85.1

76

NSF ICorps
only

86

77

I-Corps
Only

[If response to item 74 is “Yes”] Did the experience with original technology and I-Corps
result in spin-offs, new ideas, or products?
•
Yes
•
No
Regulatory Approval
[If response to company sector is "Healthcare/Medical" and company is active]
How many regulatory filings do you have for your I-Corps technology? Enter "0" if none.
Textbox

45

87

78

I-Corps
Only

[If response to # of regulatory filings is >0]
Select the options that best describe the regulatory approval status of the technology
from your I-Corps course.
Planned

Submitted

Approved

Rejected

○
○

○
○

○
○

○
○

Not
applicable
○
○

○

○

○

○

○

○

○

○

○

○

○

○

○

○

○

○

○

○

○

○

○
○

○
○

○
○

○
○

○
○

○

○

○

○

○

Premarket Approval (PMA)
501(k) Premarket
Notification
Investigational Device
Exemption (IDE)
Biologics License
Application (BLA)
Investigational New Drug
Application (IND)
New Drug Application
(NDA)
FDA facility regulations
European Conformity (CE)
Mark
Other

88

79

I-Corps
Only

89

80

I-Corps
Only

[If response to # of regulatory filings is >0]
Please describe the other types of regulatory approval your technology from the I-Corps
at NIH course has applied for.
Text box
Reimbursement Approval
[If response to # of regulatory filings is >0]
Please indicate how many of the technologies from your I-Corps course are in each stage
of the reimbursement approval status process.
Planned
Centers for Medicare &
Medicaid Services
(CMS)
Private payer
Other

□
□
□

Submitted

Approved

Rejected

□

□

□

Not
applicable
□

□
□

□
□

□
□

□
□

Clinical Trials
90

81

I-Corps
Only

91

82

I-Corps
Only

[If response to company sector is "Healthcare/Medical" and company is active]
How many clinical trials has the technology you worked on in the I-Corps at NIH course
had?
Text box
[If response to company sector is "Healthcare/Medical" and company is active]
Please indicate the number of clinical trials for the technology you worked on in your ICorps course.

Phase I clinical trial
Phase II clinical trial
Phase III clinical trial
Early feasibility
Feasibility/pilot
Pivotal
Premarket approval (PMA) device
trial
Phase IV Postmarketing study
Outside of the United States (OUS)

Planned

Ongoing

Completed

□
□
□
□
□
□
□

□
□
□
□
□
□
□

□
□
□
□
□
□
□

Not
applicable
□
□
□
□
□
□
□

□
□

□
□

□
□

□
□

Publications

46

93

84

I-Corps
Only

94

85

I-Corps
Only

95

86

I-Corps
Only

[If item 1 (involvement with I-Corps project) response is "yes, I continued to be involved
with the project"]
After your I-Corps course ended, was licensing revenue generated from the product,
service or process you developed?
•
Yes
•
No [go to item 89]
Licensing Revenue

96

87

I-Corps
Only

97

88

I-Corps
Only

[If response to item 86 (any licensing revenue generated) is "Yes"]
Please estimate the amount of licensing revenue generated from products, services or
processes.
Numeric field
[If response to item 86 (licensing revenue amount) is >0]
Please estimate the percentage of total revenue gained from licensing.
Numeric Field
New Ventures

100

89

All

101

90

I-Corps
Only

102

91

I-Corps
Only

103

92

I-Corps
Only

["If response to item 3 (whether company is active) is "yes"]
Please indicate the number of times the company name has been affiliated with a peerreviewed publication:
Numeric: open
[If response to the number of times the company name has been affiliated with a peerreviewed publication is >0]
Have any of these publications resulted from development of the technology supported
by I-Corps?
•
Yes
•
No
Generated Revenue

Many participants who have completed the I-Corps course have gone on to form new
ventures unrelated to their I-Corps projects.
Are you currently pursuing a new venture?
•
Yes
•
No
[If response to item 89 (new venture) is "Yes"]
What is the name of this new venture?
Text box
[If response to item 89 (new venture) is "Yes"]
Are you using Osterwalder's Business Model Canvas in your new venture?
•
Yes
•
No
[If response to item 89 (new venture) is "Yes"]
Are you using the customer discovery process in your new venture?
•
Yes
•
No
Other Outcomes

47

104

93

NSF ICorps
Only

[If Time 1 response]
In 2014, you gave us the following information on entrepreneurial curricula you had
developed since participating in the I-Corps course:
Course number: [TIME 1 RESPONSE]
Course title: [TIME 1 RESPONSE]
Course description: [TIME 1 RESPONSE]

105

94

All
except
for ICorps @
NIH

106

95

NSF ICorps
only

107

96

All
except
for ICorps @
NIH

107.1

97

108

98

109

99

All
except
for ICorps @
NIH
All
except
for ICorps @
NIH
All
except
for ICorps @
NIH

110

100

All
except
for ICorps @
NIH

Have you developed any additional entrepreneurial curricula?
•
Yes
•
No
[I-Corps: For all respondents with no Time 1 response to this question.]
Since participating in the I-Corps course, have you developed any entrepreneurial
curricula?
•
Yes
•
No
[If response to item 94 (entrepreneurial curricula developed) is "Yes" Or updating Time 1
response]
Please share the course number (if possible), title, and brief description of the course(s).
•
Course number
•
Course title
•
Organization
•
Course description
Did the I-Corps award lead to any collaborations between you and the external
community?
Yes
No
Industry
○
○
Investors
○
○
Local or state government
○
○
Non-profit organization
○
○
Other
○
○
[If response to item 96 is “Yes” for “Other”] Please identify any other collaborations
between you and the external community. (open-ended text box)

[If response is "Yes "for "Industry" in item 96 (individual collaborations)]
Please describe your industry collaboration(s).

[If response is "Yes "for "Industry" in item 96 (individual collaborations)]
What do you gain from your collaborations with industry?
•
Opportunities to advance the commercialization of your research
•
Opportunities to advance your research agenda
•
Neither of the above
•
Other (specify)
Did the I-Corps award to any collaborations between the university you are currently
affiliated with and the external community?
•
Yes
•
No
•
I am no longer affiliated with a university

48

111

101

All
except
for ICorps @
NIH

111.1

102

All
except
for ICorps @
NIH

[If response is "Yes" for item 100 (university collaborations)]
Which of the following collaborations between the university you are currently affiliated
with and the external community did the NSF award lead to?
Yes
Uncertain
No
Industry
○
○
○
Investors
○
○
○
Local or State
○
○
○
Government
Non-profit
○
○
○
organization
Other
○
○
○
[If response to item 101 is “Yes” for “Other”] Please identify any other collaborations
between your university and the external community.
Opportunities

112

113

103

104

All
except
for ICorps @
NIH

I-Corps
@ NIH
Only

Which, if any, of the following did you personally experience as a result of your
interactions during the [COURSE YEAR, SEASON, AND NODE] I-Corps course? Multiple
choice
Customer Interviews
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 (please describe)

Received a job
offer
□
□
□

Accepted a job
offer
□
□
□

Other
opportunity
□
□
□

□

□

□

□

□

□

□

□

□

□

□

□

Which, if any, of the following did your team (or your company)receive as a result of
interactions during the [COURSE YEAR, SEASON, AND NODE] I-Corps course? Multiple
choice.
Customer Interviews
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 (please describe)

Received a job
offer
□
□
□

Accepted a job
offer
□
□
□

Other
opportunity
□
□
□

□

□

□

□

□

□

□

□

□

□

□

□

Current Employment
113.1

104.1

I-Corps
@ NIH
Only

Were you working as a consultant during the [course name] I-Corps at NIH course?
•
Yes
•
No

49

113.2

104.2

I-Corps
@ NIH
Only

114

105

All
except
I-Corps
@ NIH

115

106

All

116

107

All

117

108

I-Corps
only

118

109

I-Corps
only

[If response to item 113.1 is “Yes”] Do you incorporate lessons learned in your I-Corps at
NIH course into your current work with consulting clients?
•
Yes
•
No
I no longer work as a consultant
Do you currently work for a college or university?
•
Yes
•
No [go to item 118]
•
Not currently employed [go to item 118]
Do you currently work for a college or university?
•
Yes, I am primarily employed at a college or university.
•
Yes, I work at a college or university as well as a private company.
•
No, I work outside of academia.
•
No, I am not currently employed.
[If response is “Yes” in item 105]
Which of the following best describes your current role? Multiple choice.
•
Tenured faculty member
•
Faculty member on track for Tenure and Promotion
•
Non-tenured Faculty
•
Non-traditional university appointment (e.g., Professor of Practice, Visiting
Scholar, etc.)
•
Research scientist
•
University Leader (Dean, Provost, etc.)
•
Administrative Staff (Academic Advisor, Center Director, etc.)
•
Student
•
Other (specify):
[If response to item 105 (whether currently working for college or university) is "No, I
work outside of academia." or "Yes, I work at a college or university as well as a private
company."]
Which of the following best describes your current employer’s primary industry?
•
Agriculture
•
Education
•
Energy & Materials
•
Environment
•
Healthcare/Medical
•
Information Technology and Communications
•
Infrastructure/Building
•
Sanitation/Water
•
Not applicable
•
Other (specify)
[If response to item 105 (whether currently working for college or university) is "No, I
work outside of academia." or "Yes, I work at a college or university as well as a private
company."]
Which of the following best describes your current employer’s company size?
•
1-10 employees
•
11-50 employees
•
51-200 employees
•
201-500 employees
•
501-1000 employees
•
More than 1000 employees
•
Other (specify)

50

119

110

All

120

111

I-Corps
Only

121

112

I-Corps
Only

122

113

I-Corps
Only

123

114

I-Corps
Only

124

115

I-Corps
Only

125

116

I-Corps
Only

125.1

117

I-Corps
Only

[If response is “No, I work outside of academia.“ in item 105]
Did your work in I-Corps lead to your current employment?
•
Yes
•
No
•
Unsure
[If response to item 110 (work in I-Corps leading to current employment) is "Yes" or
"Unsure"]
Please explain:
[If response to item 110 (whether currently working for college or university) is "No" or
"Yes"
(that is, if respondent indicated that they are employed)]
In what ways, if any, has I-Corps influenced your career?
Text Box
Other I-Corps Experiences
Have you participated in another national I-Corps team in addition to [TEAM NAME]?
•
Yes
•
No [go to item 118]
[If response to item 113 (other national team participation) is "Yes"]
Please share some information on the other team(s) you have participated in.
Team name(s)
Team company(ies)
Which course(s)
attended
Team 1
Team 2
Team 3
[If response to item 113 (other national team participation) is "Yes"]
Did the team(s) raise any government funding?
Please describe, including funding type (SBIR, PFI:AIR TT, etc.)
[If response to item 113 (other national team participation) is "Yes"]
Did the team(s) raise any private funding?
Please describe.
Involvement in I-Corps after the training can take many forms, from encouraging
colleagues to apply to the program to offering advice on SBIR applications.
In what ways, if any, do you still share information learned in the I-Corps course with your
department, colleagues, or other work-related connections?
(open-ended text box)
Demographics

126

118

All
except
I-Corps
@ NIH

127

119

All
except
I-Corps
@ NIH

128

120

All
except
I-Corps
@ NIH

What is your current gender identity?
•
Male
•
Female
•
Another identity
•
Prefer not to answer
What is your date of birth?
Date dropdown (month, day, year)
Help text: If you prefer not to answer, please leave the field blank.
What is your race? (Select one or more) American Indian or Alaska Native
•
Asian
•
Black or African American
•
Native Hawaiian or Other Pacific Islander
•
White
•
Other
•
Prefer not to answer

51

129

121

All
except
I-Corps
@ NIH

130

122

All
except
I-Corps
@ NIH

131

123

All
except
I-Corps
@ NIH

132

124

All
except
I-Corps
@ NIH

Are you of Hispanic, Latino, or Spanish origin?
•
Yes
•
No
•
Prefer not to answer
How do you describe your country of national identification?
Textbox
Help text: National identification is defined as the country with which you primarily
associate.
Have you ever served on active duty in the U.S. Armed Forces, Reserves, or National
Guard?
•
Never served in the military
•
Only on active duty for training in the Reserves or National Guard
•
Now on active duty
•
On active duty in the past, but not now
•
Prefer not to answer
Please select yes if any of the following apply to you.

Deaf or serious difficulty hearing
Blind or serious difficulty seeing even when wearing
glasses
Serious difficulty walking or climbing stairs
Other serious disability related to a physical,
mental, or emotional condition
Anything Else
133

125

All

Yes

No

○
○

○
○

Prefer
not to
answer
○
○

○
○

○
○

○
○

[If yes to item 2]
Thanks for your responses! Is there anything else you would like us to know about your [ICorps/commercialization] experience that wasn't captured by this survey?
[TEXT BOX]

52