Student Startup Application

Application for EnterpriseWorks Student Startup Initiative

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Please provide the following information to complete your Student Startup Initiative Application.



Thank you for your interest in the EnterpriseWorks Student Startup Initiative.


Student startup membership includes:

To be considered for student startup initiative space, the applicant:

Student Startup Initiative Term

Student startup status is not expected to be a long term relationship with EnterpriseWorks and is granted for one year at a time.



Company Background

Company NamePrimary ContactTitle of Primary ContactPlease provide a brief description of your business.

Primary Contact Information


Address Line 1Address Line 2CityStateZip CodePhoneEmailWebsite (If Applicable)

Legal Structure

Corporate FormState in which incorporated (if applicable)Employer Identification Number [EIN] (if applicable)

Startup Development Stage Questions


Has your firm competed in the Cozad New Venture Competition?Have you participated in the Lemelson prize competition?Have you attended Social Fuse, Invention to Venture, or other TEC/UI Entrepreneur programs?Does your firm have a prototype or initial prototype developed?Please list any entrepreneurs in residence (EIR) or other business mentors you have worked with, and describe how they have helped you.

Team

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

Product/Service


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

Market


Who are your potential customers, and what is the size of your market?Who are your key competitors?

Space Needs


How does your company plan to use space at EnterpriseWorks?What is your company's target date for tenancy?11/20/2017 ]How many people will work from the space and what is their anticipated work schedule?What space requirements do you have?What is your desired timeline for space (summer, fall semester, spring semester)?

Required Attachments


Please submit attachments for the following:Business Plan

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.YES