GIPA Startup Awards Application

First Name*

Last Name*

Job Title

Email*

Phone Number

Street Address

Suite

City

State

Postal Code

Startup Company Name*

Year Founded

Number of Employees

Industry

Startup Ecosystem Organization*

Is your startup company an incorporated entity (i.e., LLC, C-Corp, sole proprietorship) that is headquartered in Georgia?*

Yes

Have you raised less than $100,000 from accredited investors (not including grant awards or friends and family contributions)?*

Yes

What problem are you solving and how do you differentiate yourself from the competition?

How would this award help further your growth and success?

What category of intellectual property are you using to protect your company (e.g., trademarks, copyrights, trade secrets, patents)?

Have you participated in any GIPA events (need not have participated in a GIPA event to qualify), and if so, which event(s)?

Please share any additional information that you would like GIPA to use in its evaluation.

You agree that by submitting this form you have the authority to do so and that your organization satisfies the award requirements and is eligible to receive the award.*