Application Form Name of Applicant Company Date of Business Formed Business Name Registered with the Oklahoma Secretary of State? Select one Yes No Company Legal Structure Select one Partnership Corporation Sole Proprietorship Limited Liability Corporation Name of All Officers/Directors Key Contact Title Address City State Zip Phone Business Phone Mobile Phone Email Please answer the following questions (and provide the requested information) so your application can be evaluated and the appropriate support package can be developed to meet your needs.General Description of Business Description of products/services to be offered Is this new business affiliated (as a subsidiary division) with an established business? Select one Yes No If yes, name of parent business How long have you been in the business? Are you pursuing this business on a Select one Full-Time Basis Part-Time Basis How many people (including yourself and contract employees) are employed in the business? At what stage of development are the products or services you wish to market through your business? Concept Stage Prototype Stage Saleable Products/Services Stage Other How has Intellectual Property (IP) been generated, and what are your future plans for further R&D on the IP? Ownership of Intellectual Property Has the owner given permission to use IP? Does your business require any governmental or regulatory approvals? Do you have a management team established for this venture? Select one Yes No If yes, which areas of expertise does the management team possess? Prior experience with the product or service being developed by the venture Technical expertise necessary to develop the product/service Small business management expertise (Operations) Small business management expertise (Accounting) Small business management expertise (Finance) Marketing/Sales experience in the industry (or related industry) in which the product or service is to be sold Prior experience in raising capital for a new venture Please identify the industry sector or sectors that would best characterize your business and indicate the percent of business in each sector. Biosciences Advanced Manufacturing Information Technology Advanced Materials Other You may skip this section if this information is provided in the business summary. The company’s primary market Select one Local Regional National International List your major competitors Competitor 1 Competitor 2 Competitor 3 Who are your major suppliers Supplier 1 Supplier 2 Supplier 3 What are your competitive advantages What are the critical business objectives for the next three (3) months Source of Initial Capital Seed Capital Public Offering Loans Personal Savings Grants (please specify) Other (please specify) What are the major risks attached with your business? How do you plan to overcome these risks? Attach recent balance sheet and income statement if available Browse...Provide annual employment projections including number, average wage and functionProjection for years one and two in incubator programProgram Year 1 # of Full-Time Average Wage # of PT Employees Totals # of employees Function # of Management # of Technical / Engineering # of Sales / Marketing # of Entry Level Program Year 2 # of Full-Time # of PT Employees Average Wage Totals # of employees Function # of Management # of Technical / Engineering # of Sales / Marketing # of Entry Level Projection for two-year period following incubator programYear 1 # of Full-Time Average Wage # of PT Employees Totals # of employees Function # of Management # of Technical / Engineering # of Sales / Marketing # of Entry Level Year 2 # of Full-Time Average Wage # of PT Employees Totals # of employees Function # of Management # of Technical / Engineering # of Sales / Marketing # of Entry Level Approximately how much space (offices, lab, manufacturing space, special requirements, etc.) do you require now? Please provide a brief description of your challenges or needs (50 words or less). Are you willing to disclose sufficient information about your business to allow our staff and its advisors to properly assess your needs and develop the appropriate support package? Select one Yes No What do you hope to achieve by establishing a relationship with the Incubator? How did you hear about the Incubator? Please identify the type(s) of assistance you are seeking: General Business Assistance Market Research Business Plan Preparation Legal Services Intellectual Property Support Contract Development and Review Corporate Formation and Support International Accounting Services Financial Services Management/Operations Human Resources Management Team Development Educational Services Other DeclarationI declare that to the best of my knowledge the information I have provided on this form is correct and that I have not omitted any facts that may have a bearing on my application. I understand that falsification of qualifications or information may lead to dismissal of my application. Language Signature Date Name Title * Attach a Business Plan or Summary Browse... * Word verification You must fill out all required fields
