State of New Jersey
New Jersey Commission on Science and Technology
Incubator Seed Fund Grant
Guidelines and Application
Program Description
The Commission’s Incubator Seed Fund is designed to accelerate the business development process and
produce significant value for the companies receiving the awards. The Incubator Seed Fund will provide, on a
competitive basis, funds to assist emerging businesses achieve a critical milestone in their commercialization
path. The direct financial support from the Commission will compliment the mentoring and business support
provided by incubator managers as they assist these emerging companies in commercializing their technologies.
The Commission will award grants to New Jersey companies in the amounts of $20,000 to $50,000.
Timetable for Required Submission
The following timeline will be applicable to this announcement. Incomplete applications on the due dates may
result in the proposal not being reviewed or considered.
FUNDING CYCLE
APPLICATION DUE
AWARDS MADE
First Round Funding
February 25, 2010 – 3:00pm
May 2010
Company Eligibility
To be eligible for the Incubator Seed Fund Grant, the incubator client company must meet the following
requirements:
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A technology-based business that is a resident or virtual client of one of the NJCST supported
incubators
The applicant’s primary business is the provision of a scientific process, product or service and the
applicant owns, has filed for, or has a license to use protected, proprietary intellectual property.
At least 75% of employees live and work in New Jersey
Companies are limited to one (1) Incubator Seed Fund award.
Companies that have received the Edison Innovation R&D Fund or the Edison Innovation Clean Energy
Fund are ineligible to apply for the Incubator Seed Fund Grant
Companies applying for any Commission grant must be in compliance with the terms of all previous
Commission awards in order to be considered for funding.
Principal Investigator
To be awarded a grant, the primary employment of the Principal Investigator must be with the Lead Company
at the time of the application and during the conduct of the proposed research. Primary employment means that
no less than 30 hours per week is spent in the employment of the Lead Company during the conduct of the
project and no more than 19 hours per week spent in the employment of another organization.
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NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
INCUBATOR SEED FUND
Incubator Seed Fund Grant
Applicant Company Principal Investigator Information (please print or type)
Principal Investigator
& Title (Project Lead)
Company Name
Address
City
State
Telephone (business)
Fax
Zip Code
Cell Phone
E-mail Address
Edison Innovation Zone Location
Yes
No
Year Started
Company Website Address:
Tax I.D. Number:
Amount Requested
Company Match
County
Total Number of Employees:
Number of Employees Living in NJ:
Number of Employees working in NJ:
Number of Full-Time Employees::
Total Number of Employees of Parent
and Subsidiary Companies living in
New Jersey:
Annual Revenues
For each employee, please provide place of residence, municipality, county, and state. Attach
additional sheets if necessary.
Employee Name
Municipality
County/State
Hours
Worked
Per Week
Indicate whether
W-2, 1099 or
other
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NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
INCUBATOR SEED FUND
Project Summary
Provide a one page brief description of both the company and the proposed project. PLEASE USE NON-TECHNICAL,
LAY LANGUAGE. Do not include proprietary or confidential information. If the application is funded, this description
will be made public. The specific aims of this project should be in BOLD
Project Title
Please provide a brief project summary (no more than 200 words)
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NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
INCUBATOR SEED FUND
Section VIII: Eligibility and Disclosures
Have any of the persons or entities listed above:
been, within the last five years, a party in litigation?
Yes
No
been, or is now, charged with, convicted of, under indictment, on parole, on probation or a plaintiff, defendant or other
party in, any criminal or civil offense other than a minor motor vehicle violation?
Yes
No
been, or is now, subject to, or has pending, any disciplinary action by any administrative, governmental or regulatory
body?
Yes
No
been, or is now, subject to any order resulting from any criminal, civil or administrative proceedings brought against such
persons or parties by any administrative, government or regulatory body?
Yes
No
been, or is now, denied any license by any administrative, government or regulatory agency on the grounds of moral
turpitude?
Yes
No
been, or is now, informed of any current or on-going investigation with respect to possible violation by such persons or
parties of state or federal securities, anti-trust or criminal laws?
Yes
No
been, or is now, denied a business or professional-related license or had it suspended or revoked by any administrative,
government or regulatory agency?
Yes
No
been, or is now, disbarred, suspended or disqualified from contracting with any federal, state or municipal agency?
Yes
No
been, or is now, in receivership or adjudicated bankrupt?
Yes
No
been, or is now, in default on a personal or business loan?
Yes
No
is now involved in any pending lawsuits?
Yes
No
If the answer is “yes” to any of the questions above, furnish details on a separate page under the heading “ELIGIBILITY
AND DISCLOSURES”. Any information you wish to submit that may expedite this investigation should be set
forth as an attachment.
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NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
INCUBATOR SEED FUND
Application Affidavit
I, THE UNDERSIGNED, BEING DULY SWORN UPON MY OATH SAY:
1. I affirm, represent and warrant that the information contained in this application and all attachments
submitted herewith is true and complete to the best of my knowledge and that the grant applied for herein is not
for personal, family or household purposes.
2. I understand that if such information is willfully false or eligibility for the Commission’s Edison Innovation
R&D Fund is falsely certified I am subject to criminal prosecution under N.J.S.A. 2C:28-1, 2C:28-2 and 2C:283, as applicable and civil action by the Commission which may at its option terminate its grant.
3. I authorize the New Jersey Department of Law and Public Safety to verify any answer(s) and information
contained herein through a search of its records or records to which it has access and to release the results of
said research to the Commission.
4. I authorize the Commission to obtain such information including, but not limited to, a credit bureau check as
it may require, covering the applicant and/or its principals.
5. I understand that the Commission will retain this application and all associated documents, whether or not
this application is approved.
_______________________________________________
Signature of Applicant
________________________________________________
Name and Title of Applicant (Print or Type)
_________________
Date
Sworn and Subscribed before me this ___ day of ___ 20__
________________________
NOTARY PUBLIC
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NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
INCUBATOR SEED FUND
Budget:
Applicant Budget
NJCST Grant
Role on
Project
Name
Staff
% Effort
on Project
Type Appt.
(months)
Salary
Requested
FICA/Fring
e
Benefits
Total
FICA/Fringe
Benefits
Total
Federal
Other
Total
Company Funds
Role on
Project
Name
Staff
% Effort
on Project
Type Appt.
(months)
Salary
Requested
Total
NJCST
Expense Category
Company
Direct Expenses (itemize)
Personnel (see above
details)
Sub-Contractors/Consultants (itemize)
Travel (itemize)
Supplies (Itemize: Specific Supply and
Cost)
Equipment (Itemize: Specific Equipment
and Cost)
Other
Total Anticipated Expenditures
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NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
INCUBATOR SEED FUND
I certify that all information that I have provided in this application is correct to the best of my knowledge. I understand that the
Commission will retain this application and all associated documents, whether or not this application is approved. I understand that the
Commission may obtain a credit report concerning the applicant firm. I certify that the company has met all the eligibility requirements
for the Incubator Seed Fund.
I understand that deliberately making false statements on this application, or falsely certifying eligibility for the Incubator Seed Fund is
prohibited under Section 2C:28-3 of the New Jersey Code of Criminal Justice, and is punishable by fine or imprisonment.
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Signature of Applicant
Date
____________________________________________________
Name and Title of Applicant (Print or Type)
Application Submission
Send the original signed copy of the Application and the complete Grant Proposal on a CD in PDF
format to the Commission at the address below.
Overnight:
New Jersey Commission on Science and Technology
Incubator Seed Fund Grant
10 South Montgomery Street
Trenton, NJ 08625
U.S. Postal Service:
New Jersey Commission on Science and Technology
Incubator Seed Fund Grant
P.O. Box 832
Trenton, NJ 08625
For Additional Information
Please contact the New Jersey Commission on Science and Technology at (609) 984-1671 or
njcst@scitech.state.nj.us.
Note: To receive funding companies must be registered with the State of New Jersey Division of Revenue. If not
registered you can do so at http://www.state.nj.us/treasury/revenue/index.html
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NEW JERSEY COMMISSION ON SCIENCE AND TECHNOLOGY
INCUBATOR SEED FUND