Student Business Incubator Application

Missouri University of Science and Technology

Office of Technology Transfer and Economic Development
Student Business Incubator
Application Form

Applicants must complete this application in its entirety to be considered for acceptance as a Participant in the Student Business Incubator operated by the Office of Technology Transfer and Economic Development (TTED) at Missouri University of Science and Technology (Missouri S&T). Applicants must also submit a written business plan with this application. TTED may request additional information as part of the application process. Acceptance and participation is afforded at the sole and absolute discretion of TTED.

As a requirement to participate in the TTED Student Business Incubator, student businesses, their employees, and representatives must agree to abide by all policies, procedures, rules, and regulations applicable to the Student Business Incubator if accepted as a Participant. As a duly authorized representative of the applicant business, you are indicating agreement to this requirement on behalf of the business, its employees, and representatives.
Company Information
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Business Phone

Area CodePhone Number
Business Fax

Area CodePhone Number
Federal Tax ID Number
City Business License Number
Authorized Company Official
Name of Authorized Company Official

First NameLast Name
Title of Authorized Company Official
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Phone Type
E-mail

Confirmation Email
Secondary Contact Information
Secondary Contact Name

First NameLast Name
Secondary Contact Title
Secondary Contact Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Phone Type
E-mail

Confirmation Email
Business Description
Please indicate how your company is structured.
Briefly describe your product or service offering and the target customer.

0/500
Describe your company's operations that you propose to locate at the incubator.

0/500
Indicate the initial capitalization of your business.
Partnership Type
In what state is the business organized?
On what date was the business organized?
How many years has the business filed tax returns (e.g., Form 1040 Schedule C)?
In what year did the business first file with the IRS as a partnership?
List all general partners of the business:
Name any corporate parents.
List all officers of the business:
Upload attachments (e.g., business plan, financial projections, etc.)

Upload a File

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Acknowledgements
Acknowledgement Required
Acknowledgement Required
Acknowledgement Required

I understand and acknowledge that participation in the Student Business Incubator Program (SBIP) is at the sole and absolute discretion of the Office of Technology Transfer and Economic Development (TTED) at Missouri University of Science and Technology (Missouri S&T). If accepted, I agree to abide by all current and future policies, procedures, rules, and regulations of and applicable to the SBIP. I also understand and acknowledge that the SBIP itself as well as the policies, procedures, rules, and regulations of the SBIP may change at any time without notice and it is the responsibility of me and those associated with the venture to stay apprised of the current program and policies, procedures, rules, and regulations of the SBIP. Furthermore, I understand and acknowledge that if anyone associated with the business venture fails to comply with all policies, procedures, and rules of the SBIP it may result in the termination of participation in the SBIP for me as well as anyone and everyone associated with the business venture.
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Missouri University of Science and Technology

Company Information

Authorized Company Official

Secondary Contact Information

Business Description

Acknowledgements