I-Start Entrepreneur Assistance Program Application

Please provide the following information to complete your I-Start Application.



Company Background

If you are already associated with EnterpriseWorks or Research Park, please search your company here.Company Lookup (New Window)
If your company is not found, please enter your company name.

Primary Contact Information

First Name
Last Name
Title In Company
Address
Address Line 2
City
State
Zip Code
Phone Number
Email Address
Website

Company Background

Please check if your company has been formed.
If your company has been formed, please enter the Employer Identification Number (EIN)
If your company has incorporated, in which state is it incorporated?
If your company has incorporated, which type of business entity is it?

Company Ownership/Partners

Team Member #1 Name
Percentage
Team Member #1 Resume
UPLOAD

Team Member #2 Name
Percentage
Team Member #2 Resume

Team Member #3 Name
Percentage
Team Member #3 Resume

Team Member #4 Name
Percentage
Team Member #4 Resume

Are you planning to recruit additional staff and/or partners within the next 6 months?
Have you identified potential candidates?
Is your company planning to hire any students?
Do you have any advisors for the new company?
If yes, please list advisors or potential board of directors members that have been identified for the new company.
Describe any past or present affiliations that your company has had with UIUC researchers and departments for the purpose of developing its product(s) or assisting with your business development.

Intellectual Property

What is the IP status of your technology?
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Entrepreneur-in-Residence Consultation

Have you already met with an EIR to help you with your new business?
If yes, which one(s)?
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If yes, what have you worked on with them so far?
Have you attended any entrepreneur workshops or events with EnterpriseWorks or OTM to help you plan an interview for your new business?

Business Description

Please provide a brief description of your (proposed) new business.
What problem(s) are you solving for your potential customers?
List each product/service that your company intends to market.
Who are your potential customers, and what is the size of your market?
Who are your key competitors?

Incubation Needs

Why is your company applying for the I-Start Program?
What aspects of your business would your team like assistance with?
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List any other aspects of your business that your team would like assistance with.

Milestones

List the top three milestones which your company must achieve in the first year of operation.

Funding Sources

Which sources of funding are you most likely to pursue for your business in year one?
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If you selected Venture Capital/Angel Investor Financing, please complete the following questions

a. Have you begun discussions with potential investors?
b. Have any firms or angels expressed interest so far?
c. If yes, please provide more detail below.
d. Would you like to schedule a meeting with IllinoisVENTURES?

If you selected SBIR/STTR Funding, please complete the following questions.

a. Have you begun any discussions with potential agencies or identified a potential solicitation for application?
b. If yes, please provide more detail below.

If you selected Friends/Family/Personal Funding, please answer the questions below.

a. Do you or your co-founders plan to personally invest in the company to help get it started?
b. Have you identified any friends or family members who might also be early investors?
c. If you would like to provide more detail, please do so below.
If you selected Other, please provide more detail below:

I-Start Services Requested

Please select from the list below the type of I-Start services you would like.
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If you selected Legal Services, please answer the following questions.

a. What legal services would you like?
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b. What is the firm name, address, and website of your preferred legal services provider?

If you selected Business/Commercialization Planning, please answer the following questions.

a. What business/commercialization planning services would you like?
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b. What is the firm name, address, and website of your preferred business services provider?

If you selected SBIR/STTR Application/Grant Assistance, please answer the following questions.

a. What SBIR/STTR services would you like?
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b. What is the firm name, address, and website of your preferred SBIR/STTR service provider?

If you selected Financial/Bookkeeping Assistance, please answer the following questions.

a. What Financial/Bookkeeping services would you like?
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b. What is the firm name, address, and website of your preferred Financial/Bookkeeping service provider?

If you selected Shared Services, please answer the following questions

a. Which services are you most interested in?
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b. If you indicated Other, please describe in more detail below:
If there is any additional assistance you are hoping to receive as a part of the I-Start program, please describe below:

Required Attachments

Please submit attachments for the following:

1. Business Plan

2. Citations or publication about your technology to be commercialized

3. Curriculum vitae or resumes of company founders

4. Any support letters you have already received for your new business

5. Conflict of Interest Management Plan

6. OTM License Agreement

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