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Company information

Name *

Company website

Country *

Company overview *

Street address

City

State

Team overview

Source of Intellectual Property

Focus

Sector

Disease domain

Rare disease

FDA designation

Technology

Applications

Company Type

Pediatric population focus (we consider opportunities that have the potential to enter the pediatric patient population within the investment horizon of the Fund)

Previous funding

Date of previous funding round

Previous round financing stage

Previous funding round (amount, $000s)

Valuation previous round (pre-money)

Previous round(s) description

Known investors

Non-dilutive funding to date ($000s)

Equity funding to date ($000s)

Debt balance ($000s)

Capital raised to date (all sources, $000s)

Regulatory & Scientific Strategy

FDA regulatory pathway?

FDA review status

Past research achievements

What Research has been completed to date? Detail the trial protocol implemented as well as the endpoints achieved for both pre-clinical and, if applicable, human studies

What Portfolio/Pipeline research is to be pursued? What is the current R&D and program management plan? Protocol?

Pediatric innovation strategy

Proposed deal information

Stage of current financing

Target closing date

Total round size ($000s) *

Capital sought (from HIC)

Use of proceeds description *

Pre-money ($000s)

How did you hear about us?

Referred by:

Referral Comments:

Contact information

First name *

Last name *

Person email *

Phone number

Title

Website

Mobile phone number

Work phone number

Your message to us (e.g. have you talked with us already, suggested deal overview, ...) *

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