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Interested in becoming one of our Incubator Companies?

Prospective Members » Application

Application Review

Before applying using the form below you may want to review the application content first. You can download a PDF of the application at the link below

6 5 4 3 2 1

Company Information

Product Information

Market Information

Financial Information

Intellectual Property

Management and Company Information

Name of Business:		This field is required. Please enter name of business.
Business Address:	State: Zip:	This field is required. Please enter business address.
Primary Contact:		This field is required. Please enter primary contact.
Title:		This field is required. Please enter title of the primary contact.
Business Phone:	Ext:	This field is required. Please enter phone number.
Mobile:
Email:		This field is required. Please enter email address.

Describe your business, its products, and its technology.		This field is required. Please describe your business.
What significant problem does your product address?		This field is required. Please describe your product info.
Where are you in the product development cycle? Do you have a working proto-type and/or test results?		This field is required. Please describe your product development.
What differentiates your product from that of your competition?		This field is required. Please describe what differentiates your product.

Have you identified your initial target market? If yes, please explain.		This field is required. Please describe your target market.
If yes, have you talked to any customers?
Who is your primary competitor?		This field is required. Please describe your primary competitor.
What are the major barriers you are facing?		This field is required. Please describe your major barriers.

How much has been invested in your company to date and what was the source of funds?		This field is required. Please describe how much has been invested.
Has your company received any grants? If yes, indicate sources, terms and amount.	Yes No
Is your company in default on any loan covenants, rent payments or other financial obligations? If yes, please explain.	Yes No

Do you have intellectual property?	Yes No
If yes, please provide the following information.	Provisional: Yes No If yes, date filed: Applied: Yes No If yes, number: Approved: Yes No If yes, number:

Please provide the following information on all primary members of your team.		Add \| Remove
What is your experience with operating a business, particularly a start-up?		This field is required. Please describe your experience with operating a business.
Have any of your primary members ever been convicted of a felony?	Yes No
Does your company have any past or pending lawsuits? If yes, explain.	Yes No
Submitted By:		This field is required. Please enter your name.
Date:		This field is required. Please enter the date.

1. Company
2. Product
3. Market
4. Financial
5. Intellectual Property
6. Management and Company

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