The University of Texas at Austin and the U.S. Embassy Tokyo

Advancing Women and Youth Entrepreneurship
Program Application
Welcome to the UT Austin-Tokyo US Embassy Advancing Women and Youth Entrepreneurshipprogram. We are pleased to partner with institutions and organizations across Japan to recruit highpotential women and young entrepreneurs developing technologies and products with the potential for
global export. We are looking forward to engaging with you and to learning about your business idea.
The objectives of our program are to:• Build capacity and transfer knowledge related to building a successful entrepreneurial venture,
to ensure long-term sustainability;• Introduce program participants to a model and methodology which has led Austin, Texas tobecome the #1 location in the USA to develop and launch a start-up venture;• Promote entrepreneurship as a means to stimulate economic growth, create better quality jobs,
open new markets, and increase global economic security and prosperity.
• Explore opportunities to introduce selected Japanese women and young entrepreneurs to theextensive global network of the University of Texas at Austin, and the vibrant entrepreneurial
ecosystem in Austin, Texas, thereby broadening global influence and impact.
If you need guidance or have questions about the program and this application process, pleasecontact Mr. Ian Hughes, Program General Manager, at ihughes@austin.utexas.edu. Please include
your full name and product/service name as they appear on the application form.

1

Advancing Women and Youth Entrepreneurship Program Application

Contact Information
First Name

Last Name

Company Name

EmailTelephone

Mailing Address

WebsiteLinkedin Profile

Twitter Profile

Facebook Profile

Other Profile

2

Advancing Women and Youth Entrepreneurship Program Application

Has your company ever participated in a program with UT Austin?

Yes

No

If yes, please specify what has changed with your product/service since your last meeting with UT Austin.

Has your company received a Quicklook® Market Research Report?
YesNo

If yes, When was the report completed?

Was it written for the same product/service with which you are applying here?

What is the target industry for your product or service? (Select up to 2)

2

Transportation/Mobility

Entertainment

Healthcare

Real Estate

Information Technology/Hardware/Software

Financials & Fintech

RetailTextiles

Industrials & Manufacturing

Agriculture & Food

EnergyChemicalsTelecom & Communications

Social Initiatives

Utilities

OtherAdvancing Women and Youth Entrepreneurship Program Application

Product/Service Description
What is the name of your product/service?

What does the product/service do? Please explain (in simple terms) the problem/situation that thisinnovation was created to address or solve. (Limit your problem description to 100 words or less.)

Please describe the origin of the product/service, how was it invented/developed.

What was the problem that this product/service was created to solve?

Please explain (in simple terms) how this product/service addresses or solves the problem described above.
(Do not include any proprietary information in your response. Limit your description to 100 words or less.)

How do people solve this problem today?

Are there similar products/services to yours anywhere in the world?
YesNo

Why is your product/service better than what is currently available in the market?

3Advancing Women and Youth Entrepreneurship Program Application

Development Status
What is the current status of this product/service?
Concept Only
Successful laboratory model/test
Full-scale prototype
Field testing or trials underway
Fully implemented in the market
Can you provide samples of your product or testimonials of your service?
Yes

No

How many months do you estimate will be required before this product/service is completely developed
and ready for market?
Ready for Market

1–3 Months

3–6 Months

6–12 Months

12 Months or More

Commercial Status
Who is the primary customer for your product/service?

Is the primary customer, mentioned above, also the end user of the product/service?
Yes

No

If no, who is the end user of the product/service?

Is there a company or product line that may adopt or integrate your product/service into their own?
Yes

4No

Advancing Women and Youth Entrepreneurship Program Application

If yes, which companies or products lines would integrate your product/service?

Has the product/service been sold to a customer/user?
Yes

NoIf yes:
How many units have you sold?
How many customers have you sold to?
What are your total Sales by year?
What is your forecasted pipeline?

List all the countries where your product/service is being sold or has been sold.

List any distributors that sell your product/service outside of your country.

Have you recently received any inquiries from other countries to explore, acquire, or use your product/service?
Yes

NoHas your company previously received outside investment?
Yes

5NoAdvancing Women and Youth Entrepreneurship Program Application

Intellectual Property (IP) Status (Optional)
Does your product/service have IP that is protected?
Yes

No

If yes, do you own this IP or have right to operate?
Yes

No

What IP protection does the product/service currently have? (Check all that apply)
PatentCopyright
Trademark
Trade Secret
Please list any patents that have been granted or are pending.
Patent Name:
Patent Number:Issuing Country:
Patent File/Grant Date:
Patent Name:
Patent Number:
Issuing Country:
Patent File/Grant Date:
Patent Name:
Patent Number:
Issuing Country:
Patent File/Grant Date:

Has a PCT application been filed?
Yes (including US)
Yes (excluding US)
No, but planning to file
No, no current protection plan

6

Advancing Women and Youth Entrepreneurship Program Application

Certifications, Compliance, and Registration Status
Is your product/service subject to required third-party certifications?
YesNoIs the product/service registered or certified by an internationally-recognized third party?
YesNo

If yes, please list all certification and registration, and indicate if they are in process or pending action.

If no, how many months do you estimate will be required before this product/service has completed
certification and regulatory requirements?
0-3 months

4-6 months

7-12 months

13-18 months

more than 18 months

Other Supporting Information
What is your availability to support the development and commercialization of this product/service?
Full-timeHalf-time

Limited Availability

None

What level of involvement would you like to have in commercialization of the product/service?
Focus on researchParticipate in decision-making
Prepared to leave current employment to pursue commercialization
Is this product/service subject to any sensitive classification (e.g. for defense or security related technology)?
YesNo

Is there anything else you would like to share with us regarding your product/service?

What do you hope to achieve as a result of this program?

7

Advancing Women and Youth Entrepreneurship Program Application