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Better Maine 2024
SBIR Resource Center
Dirigo Labs Programs
Dirigo Labs Accelerator
Dirigo Launch Incubator
Dirigo Model
Cleantech
Meet our Cohorts
Become A Mentor
Entrepreneur In Residence
Resources
Innovation Hub
Innovation Ecosystem
Coworking
Mentor Look Book
Community
Our Region
News & Events
Press
Dirigo Speaker Series
Contact Us
DL Intake Form
Dirigo Labs Intake Form
This form will ask you questions about your business’s value proposition, business model, products and services, financials, etc. This form will take approximately 15 minutes to complete. Please answer all questions to the best of your ability.
Unique Key:
(Required)
Please refer to the email with the invitation link to find the unique key created for you
Your Name
(Required)
First
Last
Your business title
(Required)
E.g. CEO, CFO, Founder etc
Your Email Address
(Required)
Email Address
Confirm Email Address
LinkedIn
Can we find you on LinkedIn?
Telephone
Company Name
(Required)
Name of Business
Which program are you applying for?
(Required)
If you are not sure, refer to dirigolabs.org.
Dirigo Labs Accelerator
Dirigo Launch Incubator
Dirigo Model
Tell us about your business
(Required)
Briefly describe your start-up, its goals and its value proposition
Tell us about your business model
(Required)
Briefly describe your business model
What is your industry NAICS code?
(Required)
If unsure, please review the list here: https://tinyurl.com/3e7sentp
Where are you headquartered?
(Required)
Please share your start-up or venture’s location
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Number of other locations
(Required)
These would be ny other locations where you have outlets, offices or other business presence
Website
You will have to add: http://www. or https://www. before the url
When was it founded?
Please enter the date the entity was legally recognized
Employees
(Required)
How many total employees do you have? You must count the founders as employees.
Employees: FTE
(Required)
How many full time employees do you have?
Employees: PTE
(Required)
How many part-time employees do you have?
Internships
(Required)
How many interns do you have?
What is the average salary for your Full Time Employee(s)?
(Required)
$0-$19,999
$20,000-$49,999
$50,000-$74,999
$75,000-$99,000
$100,000+
What is the average wage for your Part Time Employee(s)?
(Required)
Please provide an hourly wage rate
Please enter a number less than or equal to
100
.
Do you offer paid internships?
(Required)
Yes
No
If you offer paid internships, what is the average wage?
(Required)
DEIA: Does the business identify as any of the following?
(Optional)
Woman-Owned Business
Veteran-Owned Business
Hispanic-Owned Business
Black or African American-Owned Business
Maliseet, Micmac, Passamaquody, or Penobscot Tribal-Owned Business
Alaska Native-Owned Business
Asian American-Owned Business
Native Hawaiian or Pacific Islander-Owned Business
Other
Other
Please describe “other”
Does your business or startup implement Diversity, Equity, Inclusion, and Accessibility (DEIA) in your mission, practices, or products?
Yes
No
Please briefly describe how DEIA is implemented
You can share your DEIA statement here
How many products or services do you currently offer?
(Required)
These could be revenue generating or value-adds
How many patents or other registered IP protections do you currently hold?
(Required)
Include any Open Source/Creative Commons Licenses in this count as well
How many of these are Open Source type licenses?
(Required)
Revenue and Financials
This section will ask about your current and past investments, revenues, and general finances
Revenue
(Required)
Does your start-up currently have any revenue streams?
Yes
No
Estimated Annual Revenue
(Required)
Please select one of the ranges below for your annual revenue numbers
$0 – $50K
$50K – $150K
$150K – $500K
$500K – $1M
$1M+
How many customers do you have?
(Required)
Are these the End-Users of your product or service?
(Required)
Are your products and services intended for these customer(s), or are they an entity (e.g. a retailer like Target) that resells it?
Yes
No
Other
How many users do you have?
(Required)
If your customers aren’t your users, please approximate how many end-users will be using your product or service?
How many strategic partnerships do you have?
(Required)
Has your company been through a merger, aquistion, or exit?
(Required)
Yes
No
If yes, please describe
(Required)
Have you previously raised capital?
(Required)
Yes
No
Previous: Sources of Funding
(Required)
Bootstrap (self)
Friends and Family
Grants
Crowdfunding
Angel Investor
Venture Capital
Private Equity
Loan or other Financing
Other
Previous: Describe other sources of funding
(Required)
Previous: Bootstrap amount raised
(Required)
When was the latest Bootstrap amount raised?
(Required)
Month
Day
Year
Previous: Friends and Family amount raised
(Required)
When was the latest Friends and Family amount raised?
(Required)
Month
Day
Year
Which type of grant funding did you receive?
(Required)
Federal grant (DOE, EDA, EPA, etc)
State grant (CDBG, FAME, etc.)
Charitable foundation
Corporate grant
Local grant
Maine Technology Institute (MTI)
Previous: Grant amount raised
(Required)
When was the latest Grant amount recieved?
(Required)
Month
Day
Year
Previous: Crowdfunding amount raised
(Required)
When was the latest Crowdfunding amount raised?
(Required)
Month
Day
Year
Previous: Angel Investor amount raised
(Required)
When was the latest Angel Investor amount raised?
(Required)
Month
Day
Year
Previous: Venture Capital amount raised
(Required)
When was the latest Venture Capital amount raised?
(Required)
Month
Day
Year
Previous: Private Equity amount raised
(Required)
When was the latest Private Equity amount raised?
(Required)
Month
Day
Year
Previous: Loan amount raised
(Required)
When was the latest Loan amount raised?
(Required)
Month
Day
Year
Previous: Other amount raised
(Required)
When was the latest other amount raised?
(Required)
Month
Day
Year
This field is hidden when viewing the form
Previous: Total amount raised
(Required)
Are you currently raising capital?
(Required)
Yes
No
Current: Stage of Funding
(Required)
Seed Stage
Series A
Series B
Series C
Other
Current: Sources of Funding
(Required)
Bootstrap: self, friends, and family
Grants
Angel Investor
Venture Capital
Loan or other Financing
Other
Current: Describe other sources of funding
(Required)
Current: Amount being raised
(Required)
How much equity do the founders retain?
(Required)
Answer as %
Have you applied or been granted any SBIR/STTRs?
(Required)
Granted
Denied
Application in Progress
Never Applied
Other
Please enter funded amount
(Required)
Date of award
(Required)
Month
Day
Year
Please describe grant and include agency and phase
(Required)
Which of the following ME Tax Credits are you utilizing? (Optional)
Pine Tree Development Zone
Employment Tax Increment
Business Equipment Tax Exemption
Maine Capital Investment Credit
Municipal Tax Increment Financing
Seed Capital Tax Credit
Opportunity Zones
Foreign Trade Zones
Biofuel Production Tax Credit
Renewable Chemicals Tax Credit
Renewable Energy Equipment Tax Credit
State Historical Preservation Tax Credit
Commercial Agricultural and Aquacultural Production Tax Exemption
Biotechnology Tax Exemption
Manufacturing Tax Exemption
Research and Development Tax Exemption
Custom Computer Programming Tax Exemption
Wellness Program Credit
Innovate for Maine Fellowship
Estimated value of Tax Incentives utilized
Additional Information
Pitch Deck or Company Profile
(optional)
Drop files here or
Select files
Max. file size: 32 MB, Max. files: 3.
Do you have any other information you’d like to share regarding your company or needs?
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Comments
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