Request for Entrepreneur in Residence Assistance

Please complete the following information and EnterpriseWorks will schedule an appointment for you.

First Name*
Last Name*
Email Address*
Phone Number*
How is your organization affiliated with the University of Illinois?*

If you are already associated with EnterpriseWorks or Research Park, please search your company here.Company Name Lookup (New Window)
If your company is not found, please enter your company name.
Please provide the URL for your company website, if one exists.
Please provide the business address. If no business address yet exists, please provide your personal address.*
Zip Code*
Please provide a short description of your business.*
If you have previously met with an EIR, please select their names.

With which EIR would you like to meet?*
Which topics would you like to discuss?*

What outcomes are you seeking from this EIR consultation?*
For and in consideration of receiving consultation services from the Entrepreneur-in-Residence consulting program, I consent to and hereby discharge, release, and hold harmless the Board of Trustees of the University of Illinois and the Board of Managers of the University of Illinois Research Park LLC, sponsors and their affiliates, agents, volunteers, servants, employees, successors and distributors and waives, releases and relinquishes any and all claims for liability and causes of action, including for personal injury, property damage, wrongful death, errors, and omissions arising out of consultation services from the Entrepreneur-in-Residence consulting program, and/or any activities incidental thereto, whenever or however they occur and for such period said activities may continue, and by this agreement any such claims, rights and causes of action that the Client may have are hereby waived, released and relinquished. As the Client, I have read the Liability Release and understand that I have freely given up rights by agreeing to these terms without any inducement or assurance of any nature and intend to be a complete and unconditional release of all liability to the greatest extent allowed by law.
I agree