Application Form - Merage Institute

Medical Devices / Life Sciences 2021

October 17th - October 29th, 2021

Orange County, California

This is our application form. We recommend answering all the questions that you can, even at this early stage, as this will help us make a better decision regarding your application.

All questions must be answered.

General and Contact Information

Your Name

Position at the company

Your Email

Link to your LinkedIn profile

Mobile phone number

Gender Male Female

Are you an Israeli citizen? Yes No

Date of birth (DD/MM/YYYY)

How did you hear about the program?

Short biography – 150-200 words story style (and not as a bullet/time list) in a WORD document. (doc, docx)

Your Portrait PhotoThe photo should be in color, sized such that the head is between 22 mm and 35 mm (oblong and not square proportions). The photo should be within the last 6 months to reflect your current appearance, taken in front of a plain white or off-white background, in full-face view directly facing the camera, with a neutral facial expression and both eyes open and provided in JPEG file

Information about your company

Company Name

Link to the company's website

Please describe your startup's idea in 15 words

Establishing date of the company

What is the purpose of your startup?
Which problem are you looking to solve?(must be between 1-100 words.)

Explain shortly and clearly what it does and how it is going to achieve the purpose mentioned above.(must be between 1-100 words.)

Who are your competitors? What will you do better than the competitors? Why will it be difficult for competition to copy your ideas?

What is your startup status?

Have you raised funding?

What resources will you need to develop your venture?

Describe what your company’s next steps are with respect to launching your products or services in the U.S.

What are some of the key problems you believe your company has to overcome in exporting in the U.S.?

How many people work FULL TIME at the startup (including yourself, your co-founders and full-time employees)?

Please provide the full names of all founders, and what are their specializations.(must be between 1-100 words.)

What might go wrong?

What do you and your company expect to gain from participating in the Merage Institute for U.S.-Israel Innovation Bridge Business Leadership Program for Executives.(must be between 1-100 words.)

Please upload one-pager about your startup

Last but not Least

Please approve ALL the statements below, after reading carefully.

I confirm that, if accepted to the program, I will take part in all of its meetings and activities.

I confirm that, if I attend the program, I will bear the costs of the round-trip journey to Irvine, CA.

I confirm that, if accepted to the program, I'll be fully devoted to the program.

Please enter the letters displayed:

Submit

Application Form: Medical Devices / Life Sciences 2021

General and Contact Information

Information about your company

Last but not Least