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Submit Step 2

Please Answer the Following Questions

Impact Award 2026

Step 2 Application

Full Name *

Email *

Phone *

Company Name *

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Submit video link of your 2-min pitch *

Upload headshot of founder(s) *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Please upload your company's logo *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

In one sentence, what is the change your company exists to create? *

Tell me why this mission matters to you — not your market. *

In which country/countries do you offer products/services? *

What’s the end goal? Are you building to scale or to exit? *

What are your business SMART goals in 3 years? *

What is your next quarter traction SMART goal? *

What is your current business model? *

What is your revenue model? *

Do you have an estimate of your expenses for the next 6 to 12 months? *

What has to happen in the next 6 months for this business to still make sense to pursue? *

Of these critical advisory board roles, which ones are you currently missing? *

How do you define effective leadership within your company, and how has that shaped the way you build and guide your team? *

What’s your approach to ensuring the right people are in the right roles to drive your company’s vision forward? *

On a scale from 1 to 10, how would you rate your ability to follow strategic direction, implement consistently, and communicate clearly — especially when handing off to others? *

Why did you pick the number from the last question? What helps you stay on track? vs What gets in your way? *

What inspired you to apply for the Impact Awards? *

How would winning this award accelerate your company’s growth or impact? *

Do you have cofounders? If so what are their names/titles/contact info so we can include them in this process? *

Can you describe the people and resources you’re currently using to raise capital? What roles do these supporters play—such as sourcing investor leads, performing outreach, joining investor meetings, or reviewing your pitch materials? For each, how have their activities contributed to your fundraising process so far, and what outcomes have you seen? *

Where is your current startup funding coming from? (Self-funded, loan, raising soon, not raising generating revenue etc.) *

How coachable are you on a scale of 1–10, and what would get you to a 10? *

What is your confidence level (1–10) that you’ll implement a clear plan? *

What are you focusing on right now? Select your top 3 *

What are your current challenge(s) to achieve your next 6mo goals? *

What have you already tried to solve your current challenge(s)? *

What's your CAC and Life time value? (Existing or projected). Break it down here or attach your performa excel. *

What's your monthly revenue and gross profit for the past 24 months, cash vs accrual; seasonality. Break out by product, segment, and channel *

Why are you raising now? How will you be using the fund for your business? How much are you targeting? *

What would be most supportive to you in closing this next round? *

What is your current relationship with money? (How do you think about receiving it, asking for it, managing it, or being seen with it? Be honest — this impacts how you raise.) *

On a scale of 1 to 10, how committed are you to making this fundraising round a success? *

And what are you willing to do to ensure that success — even when it gets hard, uncomfortable, or slow? (Be specific: Time, visibility, team decisions, personal growth, feedback, etc.) *

Why do you want to apply to the Health Tech Impact Award? What would winning mean for you? *

Ready to scale efficiently and break through barriers?

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