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Collaboration Request Form

1. First, Last Name
2. Email
3. Type of Request: Project pitch/Collaboration request, Mentorship request, Suggestion/Idea, Other
4. Project Name
5. Tell us about your idea/initiative – What is the idea? A device, operational project, software? Be specific.
6. What is your objective(s)? - what is the project trying to achieve
7. Why is this idea/initiative important? - summary of significance, objectives and deliverables, context and why is this needed
8. What steps have you taken thus far? – brainstorming? Prototype design?
9. What still needs to get done? – what are the next couple steps you are hoping to achieve? Prototype design? Device validation? Don’t know?
10. What do you need? - e.g. Manufacturing, personnel, research and development, brainstorming, other; how can Glia help? Be specific.