All Phase 0 Applications must be received 3 weeks prior to the Agencies
submittal deadline
Application for Louisiana SBIR/STTR Phase Zero Part I Program
Instructions for the Application
Requests for Louisiana SBIR/STTR Phase Zero Part I program funds must be submitted on the accompanying six page
application form. Adequate space is provided to respond to the specific requests in sufficient detail. A need for additional
space or attachments may be an indication that your approach is not well thought out. However, a one-page attachment is
permitted to describe extenuating circumstances. Additionally, biographical information on key personnel, including the
principal investigator, must be attached to the six-page application. The biographical information is limited to one page per
key personnel and the information must be submitted electronically.
The applicant must use 10-point type to complete the form. Times, Times Roman, or Arial typeface is preferred. The
applications are best supported by utilizing Microsoft Word to input information. Please review the Louisiana SBIR/STTR
Program information document for details regarding the Phase Zero Part I package content.
1. Submit only the 6-page application to the committee. Omit the cover page and
the instructions when submitting your application.
2. Fill out all sections in the form that are applicable to your company.
3. In order to type your information into a section, click in the area below the
required field and begin typing.
4. In order to check a box, double click on the box, change the default value to
checked, and click OK.
5. All responses must fit within the allotted space.
Application for Louisiana SBIR/STTR Phase Zero Part I Funds
Form A: Company Information
Company Information:
Office Use Only
Application #:
1.
Legal Business Name:
2. TIN #:
3.
Date:
4.
Contact Name:
6. Business Phone #:
7.
Business Fax #:
8.
Business Address:
9. City:
10. State:
12. Company E-mail Address:
5. Title:
13.
Company Web Site URL:
11. Zip Code:
14. Date Company Founded:
Company Profile:
15. Company Structure:
(Check one)
16.
17.
18.
19.
20.
21.
Sole Proprietorship
S Corporation
Partnership
Limited Liability Company
Corporation
Present number of employees:
Less than 5
51 to 100
(Check one)
6 to 15
101 to 150
16 to 25
151 to 250
26 to 50
251 to 500
Estimated Annual Revenue:
Less than $100,000
$500,001 to $1,000,000
(Check one)
$100,001 to $250,000
$1,000,001 to $5,000,000
$250,001 to $500,000
$Over $5,000,000
Type of Business:
Engineering Consulting
Service Establishment
(Check one)
Manufacturing/Producer
Wholesaler/Retailer
Research/Development
Other:
Technology Cluster:
Advanced Materials
Manufacturing/Micromanufacturing
(Check all that apply)
Agriculture Related
Medical & Biomedical Technology
Environmental Technology
Oil & Gas Production/Services
Food Technology
Petrochemical
Information Technology
Other:
Small Business Certification:
Socially & Economically Disadvantaged
Small Business Concern
(Check one)
Minority-Owned
Veteran Status
SBA 8 (a) Certified
Woman-Owned
Primary & Secondary Standard industrial codes (SIC):
22. Will all Phase I efforts be conducted within Louisiana? If not,
please explain in Section D.11.
Yes
No
Previous SBIR/STTR Experience:
23. Has your company previously received a Louisiana SBIR/STTR
24. How may SBIR/STTR Phase I or Phase II proposals have your
Phase Zero Grant?
Yes
No
company previously submitted?
25. Agency Submission
Dept of Agriculture
Dept of Health & Human Services
(Check all that apply)
Dept of Commerce
Dept of Transportation
Dept of Defense
Environmental Protection Agency
Dept of Education
NASA
Dept of Energy
National Science Foundation
26. How many SBIR/STTR Phase I awards has your company won?
28. Awarding Agency
(Check all that apply)
27. How many SBIR/STTR Phase II Awards has your company won?
Dept of Agriculture
Dept of Commerce
Dept of Defense
Dept of Education
Dept of Energy
Dept of Health & Human Services
Dept of Transportation
Environmental Protection Agency
NASA
National Science Foundation
29. Briefly Describe your Company’s Background and History:
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8000 GSRI Ave, Bldg 3000, Baton Rouge, LA 70803-6100 Phone: (225) 578-7555
Website: http://www.ltto.org E-mail: ltto@lsu.edu
Fax: (225) 578-3975
Form B: Partner Information (if applicable)
Partner Information:
1.
Legal Business Name:
4.
Contact Name:
8.
Business Address:
2.
5. Title:
12. Company E-mail Address:
TIN #:
3.
Date:
6. Business Phone #:
7. Business Fax #:
9. City:
10. State:
13. Company Web Site URL:
11. Zip Code:
14. Date Company Founded:
Company Profile:
15. Company Structure:
(Check one)
16. Present number of
employees:
(Check one)
17. Estimated Annual Revenue:
(Check one)
18. Type of Business:
(Check one)
19. Technology Cluster:
(Check all that apply)
Sole Proprietorship
Partnership
Corporation
Less than 5
6 to 15
16 to 25
26 to 50
Less than $100,000
$100,001 to $250,000
$250,001 to $500,000
Engineering Consulting
Manufacturing/Producer
Research/Development
Advanced Materials
Agriculture Related
Environmental Technology
Food Technology
Information Technology
S Corporation
Limited Liability Company
51 to 100
101 to 150
151 to 250
251 to 500
$500,001 to $1,000,000
$1,000,001 to $5,000,000
$Over $5,000,000
Service Establishment
Wholesaler/Retailer
Other:
Manufacturing/Micromanufacturing
Medical & Biomedical Technology
Oil & Gas Production/Services
Petrochemical
Other:
20. Small Business Certification:
(Check one)
Socially & Economically Disadvantaged
Small Business Concern
Minority-Owned
Veteran Status
SBA 8 (a) Certified
Woman-Owned
21. Primary & Secondary Standard Industrial Codes (SIC):
22. Will all Phase I efforts be conducted within Louisiana?
please explain in Section D.11.
Yes
If not,
No
Previous SBIR/STTR Experience:
23. Has your company previously received a Louisiana SBIR/STTR
Phase Zero Grant?
Yes
No
25. Agency Submission
(Check all that apply)
Dept of Agriculture
Dept of Commerce
Dept of Defense
Dept of Education
Dept of Energy
26. How many SBIR/STTR Phase I awards have your company won?
28. Awarding Agency
(Check all that apply)
29.
24. How may SBIR/STTR Phase I or Phase II proposals have your
company previously submitted?
Dept of Health & Human Services
Dept of Transportation
Environmental Protection Agency
NASA
National Science Foundation
27. How many SBIR/STTR Phase II awards have your company won?
Dept of Agriculture
Dept of Commerce
Dept of Defense
Dept of Education
Dept of Energy
Dept of Health & Human Services
Dept of Transportation
Environmental Protection Agency
NASA
National Science Foundation
Briefly Describe your Company’s Background and History:
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8000 GSRI Ave, Bldg 3000, Baton Rouge, LA 70803-6100 Phone: (225) 578-7555
Website: http://www.ltto.org E-mail: ltto@lsu.edu
Fax: (225) 578-3975
Form C: University Information
(if applicable)
University Information:
1.
University Name:
4.
Contact Name:
8.
Address:
5. Title:
12. E-mail Address:
2.
TIN #:
3.
Date:
6.
Phone #:
7.
Fax #:
9.
City:
10. State:
13.
Web Site URL:
11. Zip Code:
Previous SBIR/STTR Experience:
14. Has your laboratory previously received a Louisiana SBIR/STTR
Phase Zero Grant?
Yes
No
16. Agency Submission
(Check all that apply)
15. How may SBIR/STTR Phase I or Phase II proposals have your
laboratory previously submitted?
Dept of Agriculture
Dept of Commerce
Dept of Defense
Dept of Education
Dept of Energy
17. How many SBIR/STTR Phase I and Phase II awards have your laboratory won?
18. Awarding Agency
(Check all that apply)
Dept of Health & Human Services
Dept of Transportation
Environmental Protection Agency
NASA
National Science Foundation
Phase I: _____
Dept of Agriculture
Dept of Commerce
Dept of Defense
Dept of Education
Dept of Energy
Phase II: _____
Dept of Health & Human Services
Dept of Transportation
Environmental Protection Agency
NASA
National Science Foundation
Laboratory Profile:
19. Name of your laboratory or department:
21. Technology Cluster:
(Check all that apply)
20. Number of faculty researchers:
Advanced Materials
Agriculture Related
Environmental Technology
Food Technology
Information Technology
Manufacturing/Micromanufacturing
Medical & Biomedical Technology
Oil & Gas Production/Services
Petrochemical
Other:
22. Briefly describe your laboratory’s areas of research:
23. What level of participation with industry does your laboratory seek ? (Check all that apply)
None
Assist with proposal writing
Lease laboratory equipment
Project consulting
Full partnership
24. List all significant laboratory equipment and capabilities that would interest industry:
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8000 GSRI Ave, Bldg 3000, Baton Rouge, LA 70803-6100 Phone: (225) 578-7555
Website: http://www.ltto.org E-mail: ltto@lsu.edu
Fax: (225) 578-3975
Form D: Phase One Information
Solicitation Information:
1.
SBIR/STTR Agency Solicitation:
4.
Type of Application:
SBIR
STTR
5.
2.
Solicitation Topic Number:
Solicitation Closing Date:
3.
Solicitation Topic Title:
6. Have you contacted the Agency Program Manager and/or Topic Manager to
discuss details of the solicitation and possible research approaches?
Yes
No
Your Phase I Concept:
7.
Tentative title for your Phase I proposal:
8.
State the objective of your proposed research:
9.
Define the specific technical problem or opportunity addressed in the subtopic and its importance:
10. Specify the technical objectives of the Phase I work, including the questions it will answer to determine the feasibility of the proposed approach:
11. Specify the Phase I work plan as to what is planned, how and where work will be performed and the final product to be delivered:
12.
Identify corporate experience and expertise relevant to the proposed research:
13.
Describe briefly the commercialization potential of your approach:
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8000 GSRI Ave, Bldg 3000, Baton Rouge, LA 70803-6100 Phone: (225) 578-7555
Website: http://www.ltto.org E-mail: ltto@lsu.edu
Fax: (225) 578-3975
Form E: Phase Zero Information
Phase Zero Work Plan:
1.
Describe the work required to develop your Phase I proposal:
2.
Identify and discuss the principal hurdle that you must overcome in developing a competitive proposal:
3.
List the major milestones and completion dates for the development of your proposal:
4.
Describe the steps you will take to assure that the finished proposal is well organized and clearly written:
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8000 GSRI Ave, Bldg 3000, Baton Rouge, LA 70803-6100 Phone: (225) 578-7555
Website: http://www.ltto.org E-mail: ltto@lsu.edu
Fax: (225) 578-3975
Form F: Proposal Development Costs
Direct Labor Costs:
1.
Name (Company Personnel)
6. Name (Partners & Consultants):
Totals
2.
Role In Proposal Preparation:
3.
7. Role In Proposal Preparation:
Est. Hours:
8. Est. Hours:
4. Hourly Rate:
5. Total Cost:
9. Hourly Rate:
10. Total Cost:
11. Total Direct Labor Costs:
(5+10)
Other Direct Costs:
Totals
12. Travel (Specify):
13. Materials & Supplies (Itemize):
14. Other Direct Costs (Specify):
15. Total Direct Costs:
(11+12+13+14)
Indirect Costs:
16. Total Indirect Costs (Specify rate and base):
17. Total Amount Requested:
Amount Requested Should Not Exceed
$2,500
18. Total Proposal Preparation
Costs:
(15+16)
19. Cost Justification: (Briefly describe the need for each of the direct cost items.)
CERTFICATION AND ACCEPTANCE: I certify that the statements herein
are true and accurate to the best of my knowledge. I agree to comply with
all requirements of the Louisiana SBIR/STTR Phase Zero Program and
those of the federal agency to which our SBIR or STTR Phase I proposal is
submitted.
20. Signature of Company Officer/Title:
21.
Date:
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8000 GSRI Ave, Bldg 3000, Baton Rouge, LA 70803-6100 Phone: (225) 578-7555
Website: http://www.ltto.org E-mail: ltto@lsu.edu
Fax: (225) 578-3975
Instructions for Completing the Louisiana SBIR/STTR Phase Zero Application
Form A: Company Information
Required form for all company applications. University researchers should substitute Form C.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
Business Name – Enter the legal business name of the company applying for the Phase Zero grant.
TIN# - Enter the company’s Tax Identification Number or personal Social Security Number of the
Corporate/Business Authorized Representative
Date – Enter the date of Phase Zero Application
Contact Name – Enter the contact person responsible for coordinating the Phase Zero application process.
Contact Title – Enter the contact person’s title.
Business Phone # - Self explanatory
Business Fax # - Self explanatory
Business Address – Self explanatory
City – Self explanatory
State – Self explanatory
Zip – Self explanatory
Company E-mail Address – Self explanatory
Company Web Site URL – Self explanatory
Date Company Founded – Enter Month & Year the Company Began
Company Structure – Self explanatory
Present # of Employees – Check the response that applies to your company
Estimated Annual Revenue – Check the response that applies to your company
Type of Business – Check the applicable situation
Technology Cluster – Check all that apply
Small Business Certification – Check the applicable category that pertains to the business’ certification if any.
SIC – Enter the company’s primary & secondary Standard Industrial Code
(http://www.census.gov/epcd/www/naics.html )
Phase I Location - Self Explanatory
Previously Awarded Phase Zero – Self Explanatory
Previous SBIR/STTR Proposals – Self Explanatory
Agency Submission – Self Explanatory
SBIR/STTR Phase I Awards Won – Self Explanatory
SBIR/STTR Phase II Awards Won – Self Explanatory
Awarding Agency – Self Explanatory
Company Background & History – Briefly provide a description of your company’s background, history, and
experience, as well as, business and research goals.
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8000 GSRI Ave, Bldg 3000, Baton Rouge, LA 70803-6100 Phone: (225) 578-7555
Website: http://www.ltto.org E-mail: ltto@lsu.edu
Fax: (225) 578-3975
Form B: Partner Information (if applicable)
Complete this form only if the applying company is partnering with another company or the applying company is utilizing
facilities and services of another company in your Phase One Work Plan.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
Business Name – Enter the legal business name of the company to which is applying for the Phase Zero grant.
TIN# - Enter the organization’s Tax Identification Number or personal Social Security Number of the
Corporate/Business Authorized Representative
Date – Enter the date of Phase Zero Application
Contact Name – Enter the contact person responsible for coordinating the Phase Zero application process.
Contact Title – Enter the contact person’s title.
Business Phone # - Self explanatory
Business Fax # - Self explanatory
Business Address – Self explanatory
City – Self explanatory
State – Self explanatory
Zip – Self explanatory
Company E-mail Address – Self explanatory
Company Web Site URL – Self explanatory
Date Company Founded – Enter Month & Year Company Began
Company Structure – Self explanatory
Present # of Employees – Check the response that applies to your company
Estimated Annual Revenue – Check the response that applies to your company
Type of Business – Check the applicable situation
Technology Cluster – Check all that apply
Small Business Certification – Check the applicable category that pertains to the business’ certification if any.
SIC – Enter the company’s primary & secondary Standard Industrial Code
(http://www.census.gov/epcd/www/naics.html )
Phase I Location - Self Explanatory
Previously Awarded Phase Zero – Self Explanatory
Previous SBIR/STTR Proposals – Self Explanatory
Agency Submission – Self Explanatory
SBIR/STTR Phase I Awards Won – Self Explanatory
SBIR/STTR Phase II Awards Won – Self Explanatory
Awarding Agency – Self Explanatory
Company Background & History – Briefly provide a description of your partnering company’s background,
history, and experience, as well as, business and research goals.
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8000 GSRI Ave, Bldg 3000, Baton Rouge, LA 70803-6100 Phone: (225) 578-7555
Website: http://www.ltto.org E-mail: ltto@lsu.edu
Fax: (225) 578-3975
Form C: University Information (if applicable)
Complete this form only if the applicant is a Louisiana university faculty member applying for Phase Zero Part I funding
through your university affiliation or the applicant is a company utilizing the facilities and services of a Louisiana university
or research center.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
University Name – Enter the legal business name of the company to which is applying for the Phase Zero
program.
TIN# - Enter your university’s Tax Identification Number.
Date – Enter the date of Phase Zero Application
Contact Name – Enter the contact person responsible for coordinating the Phase Zero application process.
Contact Title – Enter the contact person’s title.
Phone # - Self explanatory
Fax # - Self explanatory
Address – Self explanatory
City – Self explanatory
State – Self explanatory
Zip – Self explanatory
E-mail Address – Self explanatory
Web Site URL – Self explanatory
Previously Awarded Phase Zero – Self Explanatory
Previous SBIR/STTR Proposals – Self Explanatory
Agency Submission – Self Explanatory
SBIR/STTR Phase I Awards Won & SBIR/STTR Phase II Awards Won – Self Explanatory
Awarding Agency – Self Explanatory
Name of Lab – Self Explanatory
Number of Faculty Researchers – Self Explanatory
Technology Cluster – Self Explanatory
Labs Area of Research – Briefly describe the Labs areas of expertise and research experience.
Level of Participation with Industry – Self Explanatory
Lab Equipment – Briefly describe the lab facilities that will be utilized in the Phase I process
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8000 GSRI Ave, Bldg 3000, Baton Rouge, LA 70803-6100 Phone: (225) 578-7555
Website: http://www.ltto.org E-mail: ltto@lsu.edu
Fax: (225) 578-3975
Form D: Phase I Information
Required form for all applicants.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
SBIR/STTR Agency Solicitation – Enter the name of Federal agency to which you submit your Phase One
proposal.
Solicitation Topic Number – Enter the Federal agency’s topic number listed in the solicitation for the toic you are
addressing.
Solicitation Topic Title – Enter the agency’s title listed in the solicitation for the topic you are addressing.
Type of Application – Indicate whether the topic is an SBIR or STTR solicitation.
Solicitation Closing Date – Enter the Federal agency’s solicitation closing date to which you are applying.
Have you contacted the Soliciting Agency – Discussing details of the solicitation and possible research
approaches are highly recommended. The agencies’ Project Managers often provide additional information and
insights to their programs that would be beneficial in developing your proposal.
Tentative Title for your Phase One Proposal – Should reflect the substance of the project and must be limited
to 120 characters and spaces. Do not use the solicitation’s topic title.
State the Objective of your Proposed Research – Must be stated in one concise sentence.
Describe the Technical Problem or Opportunity – Provide a preliminary description of the Technical Approach
you will propose to solve the agency’s research needs. Be concise, but thorough, using only the space provided.
Technical Objectives of Phase I Work – Briefly describe technical objectives to determine feasibility of proposed
approach.
Describe Phase I Work Plan – Briefly describe what the company plans on doing and where company will
perform work in the Phase I time period.
Identify Corporate Experience – List relevant past activities and available resources that your organization can
bring to bear on the proposed research beyond your own personal expertise.
Briefly Describe the Commercialization Potential of your Approach - Commercialization potential will be an
important component of your Phase I proposal. Provide a brief statement to show that your approach can lead to
a marketable product.
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8000 GSRI Ave, Bldg 3000, Baton Rouge, LA 70803-6100 Phone: (225) 578-7555
Website: http://www.ltto.org E-mail: ltto@lsu.edu
Fax: (225) 578-3975
Form E: Phase Zero Information
1.
2.
3.
4.
Describe the Work Required to Develop your Phase I Proposal – Be concise, but thorough, using only the
space provided.
Identify and Discuss the One Principal Hurdle that you Must Overcome in Developing a Competitive
Proposal – The response primarily will assist reviewers in determining the applicant’s awareness of the
components of a strong proposal and the applicant’s resourcefulness in addressing the issue. The seriousness of
the identified hurdle is not a factor in the evaluation.
Provide a List of Major Milestones and Completion Dates for the Development of your Proposal – Include
submission of a final draft of your proposal to LTTO at least two weeks prior to the Federal agency’s final
submission date.
Describe the Steps that You will take to Assure that the Finished Proposal is Well Organized and Clearly
Written - The quality of presentation is a critical component of any proposal. The best ideas may never be
funded if not effectively presented to the reviewers. Whether your team is a veteran of numerous proposal
submissions or this is your first attempt, you are required to state the expertise or resources you will use to ensure
that your proposal is concise, well-written, and possesses an effective use of graphics and a neat appearence.
Applicants are advised to take advantage of the resources of the LTTO, the local Small Business Development
Centers, as well as numerous proposal writing guides, software, and consultants. LTTO will review the final draft
that you submit to them two weeks prior to the Federal agency’s submission date, and make recommendations.
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8000 GSRI Ave, Bldg 3000, Baton Rouge, LA 70803-6100 Phone: (225) 578-7555
Website: http://www.ltto.org E-mail: ltto@lsu.edu
Fax: (225) 578-3975
Form F: Proposal Development Costs
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Name – Enter the names of personnel working for the organization that is submitting the Phase Zero application
who will be developing the proposal.
Role in Proposal Preparation – Enter the title or function that the individual will play in proposal writing.
Estimated Hours – Enter the number of hours that each person actually is estimated to work on the Phase One
proposal.
Hourly rate – Enter the hourly wage of each individual working on the Phase One proposal.
Total Cost – Hourly rate (box 4) x estimated hours of the individual (box 3).
Name – Enter the names of consultants or personnel from partnering organizations who will work on the Phase
One proposal.
Role in Proposal Preparation – Enter the title or function that the individual will play in proposal writing.
Estimated Hours – Enter the number of hours that each person actually is estimated to work on the Phase One
proposal.
Hourly rate – Enter the hourly wage of each individual working on the Phase One proposal.
Total Cost – Hourly rate (box 9) x estimated hours of the individual (box 8).
Total Direct Labor Costs – Total the costs of all labor entered in box 5 and 10.
Travel – Estimate all travel-related expenses at rates typically accepted by the State. As a guide, the State of
Louisiana automobile mileage rate is $0.308/mile.
Materials and Supplies – Identify any materials that will be purchased for the development of the proposal (e.g.,
laboratory supplies for preliminary experiments.)
Other Direct Costs – List all other items that will be purchased for the development of the proposal (e.g.,
technical manuals, proposal writing guides and software.)
Total Direct Costs – Add the numbers in boxes 11, 12, 13, and 14.
Total Indirect Costs – Specify rate and base. Use the current rate already negotiated with a federal agency, if
available. If no rate has been negotiated, a reasonable estimated rate should be used. Louisiana universities
must use the Board of Regents required rate of 25% of total direct labor costs only. Start-up companies that are
not familiar with calculating their indirect costs should submit a ballpark estimate if anticipated overhead costs, but
should be aware that a more precise indirect cost rate will be required on the Phase One proposal.
Total Amount Requested – Enter the amount of Phase Zero funds you are requesting up to a maximum of
$2,500.00.
Total Proposal Preparation costs – Sum the total of direct costs (box 15) and total indirect costs (box 16). This
number should represent the actual estimated costs you expect to encounter to complete the Phase One proposal
and may not be the same as the amount requested in box 17.
Cost Justification – Briefly describe the need for each of the direct cost items.
Signature of Company Officer – The signature of the Corporate/Business Authorized Representative who is
empowered to make contractual commitments on behalf of the small business or university is required before
funds can be awarded. On the electronically submitted form, type the name of this individual. However, the
original should be signed and mailed to the LTTO later along with other documentation described in section III of
the Phase Zero Program Description pamphlet.
Date – Enter date of signature,
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8000 GSRI Ave, Bldg 3000, Baton Rouge, LA 70803-6100 Phone: (225) 578-7555
Website: http://www.ltto.org E-mail: ltto@lsu.edu
Fax: (225) 578-3975