Application for EnterpriseWorks Affiliate Clients


Please provide the following information.



Thank you for your interest in becoming an EnterpriseWorks affiliate!


The affiliate membership package includes:

  • Co-working Desk Space
  • Conference Rooms
  • Wi-Fi and Ethernet Ports
  • Shared Kitchen with Free Coffee and Snacks
  • Events and Free Lunch Programs
  • Reception Services
  • Copy machine, Printers, Projectors
  • Video Conferencing Services
  • Tech Community of 1400 Professionals
  • EnterpriseWorks business address and mailbox

To be considered for affiliate status, the applicant:

  • Must be a for-profit business
  • Must have a real need for the services offered through EnterpriseWorks
  • Must be a technology-based business with commercial potential
  • Must have well-qualified principals involved with the business

Guidelines for affiliates:

Affiliate Status is not expected to be a long-term relationship with EnterpriseWorks. We will not market company affiliation as Research Park or EnterpriseWorks tenancy. Affiliate status is granted for one year at a time and should not be renewed for more than three years total. It is fair to say that different types of companies require different lengths of development time to achieve financial sustainability depending upon the technology involved.

As a general rule of thumb, a company should no longer be an Affiliate if one or more of the following conditions exists:

  • The company is renting space at EnterpriseWorks or another location or has a physical company operation in another location
  • The company has no continuing need for incubator services
  • The company has been acquired

Company Background

Company Name
Primary Contact
Title of Primary Contact
Please provide a brief description of your business.


Primary Contact Information

Address Line 1
Address Line 2
City
State
Zip Code
Phone
Email
Website (If Applicable)


Legal Structure

Corporate Form
State in which incorporated
Employer Identification Number (EIN)

Team

Team Member #1 Name & PositionTeam Member #1 Resume
UPLOAD

Team Member #2 Name & PositionTeam Member #2 Resume

Team Member #3 Name & PositionTeam Member #3 Resume

Team Member #4 Name & PositionTeam Member #4 Resume

Team Member #5 Name & PositionTeam Member #5 Resume

Is your company planning to recruit additional staff and/or partners?
If yes, is your company planning to hire any students?

Ownership of Company

Please provide information about owner #1

Individual/Entity
Percent of Ownership


Please provide information about owner #2

Individual/Entity
Percent of Ownership


Please provide information about owner #3

Individual/Entity
Percent of Ownership


Please provide information about owner #4

Individual/Entity
Percent of Ownership


Please provide information about owner #5

Individual/Entity
Percent of Ownership

Product/Service

List each product/service that your company has marketed or intends to market.


Incubation Needs

Why is your company applying to become an Affiliate of EnterpriseWorks?
What do you need help with?
Add

Remove
What else do you need help with?


Milestones

Must have three answers in format: 1. 2. 3.
List the top three milestones which your company must achieve in the first year of operation.

References

Reference #1: Name, email, phone.
Reference #2: Name, email, phone.
Reference #3: Name, email, phone.

Required Attachments

Please submit attachments for the following:
Conflict of Interest Management Plan or status update (required for UIUC faculty).

Bank statement and pro forma projections.

Office of Technology Management License Agreement or status update (if applicable).

Certification


By checking the YES box below, I certify that all the information contained in this application is true and complete. I authorize the EnterpriseWorks incubator staff at the University of Illinois to verify the information contained on this application by contacting the references given. I understand that this application, when submitted, becomes the property of the EnterpriseWorks incubator and that the application will be retained by EnterpriseWorks whether or not the application is approved. I also understand that the information contained in this application will be used only to determine my eligibility to lease space in EnterpriseWorks and will be kept confidential.
I agree