Success Story Submission Form

1. *Name:
2. *Organization:
3. *Phone:
4. Ext:
5. Fax:
6. *Email:

(*Select One)

1. Topic Number:
2. *Title:
3. Contract Number:

Small Business Company Information

4. *Company Name:
5. *Company Contact
6. Address:
7. Phone:
8. Ext:
9. Fax:
10. E-mail:

Technical Point of Contact (TPOC)

11. Name:
12. Address:
13. Phone:
14. Ext:
15. Fax:
16. Email:

SBIR/STTR Program Manager

17. Name:
18. Address:
19. Phone:
20. Ext:
21. Fax:
22. Email:

SPO Transition Office/Contact (Transition Story Only)

23. Name:
24. Address:
25. Phone:
26. Ext:
27. Fax:
28. Email:

Air Force Requirements

29. Briefly (3 or 4 sentences) describe why the Air Force needed the technology.
    

SBIR/STTR Technology

30. Briefly (4 or 5 sentences) describe the SBIR/STTR Technology.
    

Potential Air Force Impact (For Innovation Story)

31. How/where may this technology make an impact on the Air Force?
    

Transition Impact (For Transition Story)

32. How/where is the technology being used today? What Air Force /Department of Defense system/subsystem does it support? How will this technology make an impact on the Air Force?
    

Company Impact

33. What was the SBIR/STTR Program meant to the small business in terms of commercial sales/company growth/product development? This statement may be in the form of a quote from the President/CEO.