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Emerging Enterprise Center Application

I. APPLICANT INFORMATION
Information submitted will be held in confidence and used for purposes of evaluation for EEC admittance.
Address Block - US
Please list by name and title and attach resumes
II. GENERAL DESCRIPTION OF BUSINESS
Corp., Sole Proprietorship, LLC, etc.
e.g. working on prototype, product in advanced development, etc.
Format: M/d/yyyy
Sales Revenue:
e.g. working on prototype, product in advanced development, etc.
e.g. working on prototype, product in advanced development, etc.
e.g. working on prototype, product in advanced development, etc.
Current Number of Employees:
This includes Principal Officer
e.g. working on prototype, product in advanced development, etc.
e.g. working on prototype, product in advanced development, etc.
How many employees do you expect to have in:
e.g. working on prototype, product in advanced development, etc.
e.g. working on prototype, product in advanced development, etc.
Type of Financing Employed to Date
Do you have sufficient financing or product revenues to pay rent for six (6) months?
You can be expected to provide appropriate supporting documentation ( e.g. bank statements, financial records, tax statements)
Status of Business Plan
Do You Need Assistance?
Format: M/d/yyyy
III. USAGE OF INCUBATOR SPACE
Approximate Space Requirements:
The EEC offers a variety of offices sizes with space beginning at about 150sq. ft.
If yes, please describe.
If yes, please describe and provide technical specifications.
Format: M/d/yyyy
IV. CERTIFICATION AND RELEASE
Electronic Signature:
All of the statements made in this application are true, accurate and complete to the best of my knowledge. I understand that any false statement or material omission may lead to disqualification of this application, or eviction from the EEC program if admitted to tenancy.
Format: M/d/yyyy