* Project Name:

Brief Technology Description:

Award Request Type:
(please select one)

Pre-Seed Commercialization Award ($250K or less)

Commercialization Award (typically $500k to $2.5M)

• Indicate how much prior equity has been raised (pre-seed applicants can have no more than $500k prior equity raised):
  
  

Award Request Amount:

* Company Name:

* Contact's First Name:

* Contact's Last Name:

Job Title:

* Primary Phone #:

Alternate Phone #:

* Email Address:

County:(location of primary presence in Rio Grande Valley region)
Select one... Brooks Cameron Dimmit Duval Edwards Hidalgo Jim Hogg Jim Wells Kenedy Kinney La Salle Maverick Real Starr Uvalde Val Verde Webb Willacy Zapata Zavala Other

Newletter:
I grant permission to be on the Rio Tech Fund, Inc. email distribution list.

Company Type (choose one):
We are a private company.

• Current company structure (C-corp, S-corp, LLC...)*
  

*Note: If not a C-corp, must be willing to convert to C-corp before the application will be submitted to the State. The restructuring can be deffered until after the Rio Tech Fund board meeting before the State deadline (typically 2-3 weeks).

We are a public company.

• Please explain why you cannot raise other funds for this project.
  

To be eligible for an award you must meet all the following criteria:

We are commercializing an Emerging Technology:

• Select industry:
  Select one... Aerospace Biotechnology Computer and software technology Defense Energy Information Manufactured energy systems Micro-electromechanical systems Nanotechnology Semiconductors Medicine Life sciences Petroleum refining and chemical processes Other area

We are partnering or will partner with a Texas public or private university.

• Indicate university and relationship, and how this relationship will impact the commercialization of this technology:
  

We have a defined project scope, commercialization path and business plan.

This project will have a demonstrable economic impact in Texas.

• This includes a guarantee of commercialization or manufacturing in Texas. The economic impact could be the creation of high-paying jobs in Texas, economic benefits to other partners located in Texas, or increasing the State's national or global competitiveness in key emerging technology industries

This project has recently raised or will commit to raise matching funds from other sources.

• The matching funds should be at least as large as the requested amount.
  

The company has clear ownership of the technology's IP.

• Typical industry accepted practices can be used to protect the technology (trade secret, copyright protection, employee agreements, time-to-market, ...)
• Please briefly summarize how the company's IP is protected:
  

This project may result in a scientific or medical breakthrough, or a breakthrough in clean energy technologies.

• Your technology may be considered a breakthough if your technology solves a new problem and is a significant improvement over current technologies
• Explain why you have breakthrough technology:
  

We have documentation of independent validation of the specific technology that will be the basis of the application.

• Validation can be from successful prototype or pre-production testing of the technology by potential customers.

If funded, we accept an equity investment by the State AND (for Pre-Seed applicants only) we would be willing to accept up to the first $500K from the State as convertible debt.

I/we give RGRCIC full permission to forward all information I/we provide to RGRCIC to any parties, public or private, involved in the evaluation of my/our ETF application. By writing my name and my company name in the box below, I certify that I am authorized to sign this document on behalf of the company:

• * Company Name:
• * Company Officer Name: