1.	Business Name
	Principal Officer(s) and Title(s)
	Telephone Number
	Fax Number
	E-Mail
	Street Address
	City
	State
	Zip Code

2.	a.	Nature of Business (Brief description of product/service and why your product/service will be successful): Nature of market; submit product brochures and company literature if available. Complete Executive Summary section below.
	b.	What intellectual property do you have, and who owns the rights to it?

3.		Brief Background of Principal Officer(s). (Append resumes) List at least two previous employers and contacts.

4.		Date Business Established

5.		Current Status of Business. (e.g., working on prototype, product in advanced development, etc.).

6.		What is the legal structure of your company?
		Sub-S	LLC	Corporation	Other:

7.		Number of Employees (including Principal Officer)?
		Full-time:		Part-time:

8.		Anticipated number of new jobs created?
		Year 1:	Year 2:	Year 3:

9.		Type and Amounts of Financing to Date:
		a.	Complete and submit Sources and Uses Statement for next 18 month period.
		b.	Email your cash flow statements for the next 12 months (to techcenter@umbc.edu).
		c.	A personal financial statement may be required.

10.		Status of Business/Marketing Plan:
			Business/Marketing Plan Completed and Available for Review. (Please email to techcenter@umbc.edu.)
			Business/Marketing Plan in Preparation.   Date Available:
			Business/Marketing Plan Not Started

11.		Do you need help in writing a business/marketing plan?
		Yes	No

12.		What types of business assistance do you believe your company needs?

13.		Will your company be seeking potential UMBC collaboration? Please define:
			Research and Development with Faculty
			Student Internship
			Student Employment
			Other:

14.		Approximate Space Requirements:
			Square Feet - Office
			Square Feet - Labs
			Square Feet - Other (Specify):

15.		Special Facility Requirements? (Electrical, ventilation, floor load, etc.)

16.		Approximate date you desire to locate in the incubator?

17.	Name
	Electronic Signature
	Title
	Date