Founder Introduction Form

Founder Introduction Form

We invest in extraordinary entrepreneurs and invite them to join the StartUp Health platform to become lifetime members of our global army of Health Transformers.
Prior to joining, you will meet with our Ventures team so we can get to know you and the health moonshot you are working to achieve. As a first step, please complete this Founder Introduction Form - answering a few simple questions about you and your company.

Founder Information
First Name *
Last Name *
Company Name *
Title *
Email *
example@example.com
LinkedIn Profile *
Please include a direct link
Founder Bios (backgrounds, roles and full-time/part-time status) *
Founder Introduction Video *
Please create a video to introduce yourself to the StartUp Health team (tell us about your background and why you are passionate about your company's vision)! Enter the URL of a 60-90 second video (unlisted on YouTube, Vimeo, etc.).
Are you willing to provide peer support to other Health Transformers in the StartUp Health community? *

Yes No
Your Moonshot Vision
Company Website *
Please include a direct link
Which primary Health Moonshot are you working to achieve? *
Which secondary Health Moonshot are you working to achieve?
If your company falls within more than one moonshot, select the secondary moonshot here
Which tertiary Health Moonshot are you working to achieve?
If your company falls within more than two moonshots, select the tertiary moonshot here
Tell us about your company's long-term vision and moonshot impact. *
Describe what your company does in 140 characters or less. *

0/140
What are your top three challenges/needs? *
What are your top three strengths/opportunities? *
Company Information
Presentation Link *
Please provide a link (Dropbox, Google Drive, etc.) to your most recent presentation deck.
Company's Primary Location *
City, St and/or Country
Number of Full-Time Team Members *
Working solely, full-time on the company
Team Diversity - please let us know if any of your founders fit in the categories below by checking the applicable boxes *

Female Founders MD/PhDs BIPOC Serial Entrepreneurs LBGTQ+ None of above Prefer not to answer
Advisor/Board Member Bios *
Your Product Stage *

Concept Prototype Beta Market
Please provide short overview on your current traction (revenue, user/pilot metrics, product development/validation, etc.) *
Total Capital Raised to Date (type and amount) *
(e.g. $200K F&F or $5M Series A, etc.)
How are you currently funding the business (revenue, grants, founder investment, external investment, etc.) and how many months runway do you have? *
How did you hear about StartUp Health? *

COVID-19 Call for Innovation Call for Innovation Website Newsletter Social Media Industry Event StartUp Health Magazine Met StartUp Health Team Member Referral Attended StartUp Health Festival
StartUp Health Team Member met or referred by: *

Steven Krein Unity Stoakes Katya Hancock Bari Krein Lauren Schafer Logan Plaster Jennifer Hankin Max Owen Anne Dordai Priya Reddy
Referred By: *
Your Phone Number *

Area Code Phone Number
Your Mailing Address
Street Address *
Street Address Line 2
City *
State
(if a U.S. company)
Postal / Zip Code *
Country *
Founder T-Shirt Size *

Small Medium Large X-Large
Should be Empty:

Founder Introduction Form

Founder Information

Your Moonshot Vision

Company Information

Your Mailing Address