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Company
You may use a placeholder name if you do not yet have an established company.
Company Type
You may use a placeholder if you do not yet have an established company.
Company Type - Other:
State of Incorporation:
First Name
Last Name
Email
Phone
Street
City
State/Province
Zip
Country of Company Origin:
Please introduce your venture, the problem you are solving and your proposed solution:
Who are your customers and/or users and what stage of customer discovery you are in?
What is the unique value proposition you plan to provide to your customers?
What is your business model? How do you plan to make money?
Briefly list the team members. List each team member’s significant contribution/s to the venture:
Briefly describe where funding currently comes from and your funding plans for the next 24 months:
What is the current status of the product/service you provide?

Idea Stage
Prototype
Customer-Ready
In the Market

What services do you hope to obtain from the University of Arizona Center for Innovation?

Mentorship
Offices
Access to Labs
Investment Support
Connections to Community Support
Connections to the University of Arizona
Connections to Other Startup Entrepreneurs

Please indicate if you have any connection to the University of Arizona. This is not required for participating in this program but for informational purposes only.

Negotiating a License Agreement
License Agreement
UA Student
UA Alumni
Other
No UA Connection

What steps have you taken – or do you intend to take – to protect the intellectual property embodied in the innovation?
What milestones does the team intend to complete during the next 6-12 months?
What do you feel are the biggest challenges facing your venture?

Market Validation
Developing Business Model
Expanding Team
Fundraising
Technology Development
Securing Intellectual Property
Operations
Facilities