Events:

05/21/2013 - Dialogue with SCORE Representatives at CBBIC

05/28/2013 - Dialogue with SCORE Representatives at CBBIC

07/18/2013 - Coastal Bend Business Innovation Center - Committee Meeting

08/15/2013 - Coastal Bend Business Innovation Center - Advisory Board Meeting

10/17/2013 - Coastal Bend Business Innovation Center - Committee Meeting

Full Calendar

Student Incubator Application

Legal Name of Company: *
Business Federal Tax ID:
Person Completing Application: *
Student ID: *

Section 1 - GENERAL INFORMATION
PRIMARY CONTACT	SECONDARY CONTACT
Name: *	Name:
Title: *	Title:
Home Address: *	Home Address:
City: *	City:
State: Select Alabama Alaska Alberta Arizona Arkansas British Columbia California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virignia Washington West Viriginia Wisconsin Wyoming Yukon *	State: Select Alabama Alaska Alberta Arizona Arkansas British Columbia California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virignia Washington West Viriginia Wisconsin Wyoming Yukon
Zip: *	Zip:
Cell Phone: *	Cell Phone:
Other Phone:	Other Phone:

If there is a lease, who would be legally responsible for it?
What is your current student status: * Undergraduate - Freshman Undergraduate - Sophomore Undergraduate - Junior Undergraduate - Senior Graduate Student
What is your current academic major: *
What is your expected graduation date: *
Type of Company: * Sole Proprietoship LLC Limited Subchapter S Corporation Subchapter C Corporation General Partnership
Define your Industry: *
Is the business currently in operation? * Yes, What year was it founded? No, Current Employer?
Do you currently have a business license? * Yes, Where? No
Do you have a unique business idea or a patented or proprietary technology or idea? * Yes No
Describe your past business experience/education: * (Please attach a current personal resume, emphasizing your educational and/or business experience) Resume:
Section 2 - BUSINESS PRODUCT / SERVICE INFORMATION
What is your product/service? *
What makes your business, product, service, or process "innovative"? *
Do you have a written Business Plan: * Yes No, but I am willing to complete one within the first three months in the center
Briefly describe the market for your product/service:
In what geographic area are your customers located?
Is 75% or more of your market potentially outside the coastal bend area? Who are your principal competitors in the Coastal Bend area? * Yes No
Who are your principal competitors in the Coastal Bend area?
Other principal competitors outside Coastal Bend area?
What is your competitive advantage?
How will you market and distribute your product or service: Direct Market Sales Force Personal Contacts Made By Owner Publication Others (Please explain)
Are you a new start-up company or an existing business that has not met its full growth potential? * Yes No Other
Do you plan on hiring within the next 24 months? * Yes No
Do you have sufficient funds/income to cover living and operating expenses until the business reaches profitability?
What is your source of funds/income?
Where are you planning to base your headquarter upon graduation from the CBBIC?
Why are you applying to join the Coastal Bend Business Innovation Center?

Section 3 - BUSINESS SERVICE NEEDS
What type of services and consultation do you need from the CBBIC?
What types of office support services does your business require? Internet Access Photocopier Receptionist Mail Handling Fax Machine Document Printer Document Scanner Word Processing Conference/Training rooms Other (Please explain)
Do you currently have an Accountant? * Yes No
Do you currently have and Attorney? * Yes No
Do you need management assistance? * Yes No
If yes, describe need:
Do you need marketing assistant or other kind of assistance? * Yes No
If yes, describe need:

Section 4 - REFERENCES
BANK	CREDIT REFERENCE #1	CREDIT REFERENCE #2
a. Bank Name: b. Principal Contact: c. Phone Number: Business: Personal:	a. Business Name: b. Principal Contact: c. Phone Number: Business: Personal: Type of Account:	a. Business Name: b. Principal Contact: c. Phone Number: Business: Personal: Type of Account:

I hereby apply for admission to the Coastal Bend Business Innovation Center. I understand that the information contained in this application will be held in the strictest confidence. I understand that, as part of the screening process, my credit history and financial references may be investigated, and a criminal background check may be conducted.

I further understand that this application is subject to review and in no way guarantees my admission to the Innovation Center, and that no liability will be assumed by the Coastal Bend Business Innovation Center. The Director of the Innovation Center retains sole and exclusive authority to accept or reject applications.

I have completed this application in its entirety and certify to its accuracy and release this information to the Coastal Bend Business Innovation Center.

Submitted by Name: *
Title: *    Date: 05/21/2013