Partnership Application Please fill out the fields below. Those with a * are necessary fields in order to complete the application. Once it is complete, you will receive a confirmation email, and a copy of your application. Step 1 of 3 33% Company InformationCompany Name*Company Operating NamePlease provide your operating name if it is different from your legal nameContact Name* First Last Contact Title*Company Address* Street Address City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Phone*Company Email* Enter Email Confirm Email Website Company Type*Choose Company TypeRegistered CharityGovernment/InstitutionFor Profit CompanyNot for ProfitIs your business registered in Canada?*YesNoIf so, what year was it registered?Canadian Revenue Agency Business #*How many employees (FTE) does your company have?*Please enter a number greater than or equal to 1.How many new product(s)/service(s) has your company successfully developed and sold?*# of products/servicesNoneOneMore than OneProvide a brief overview of your company and its products or services:* Project InformationDescribe your proposed project:*What is the specific challenge this project should address? Why is it a challenge to your company?*Does your company have a proposed solution to this challenge? Provide details of any existing, or partial solutions, which are currently available.*What are the goals of a successful project outcome? (check all that apply)* Increased revenue Decreased costs New market development Increased employees Increased productivity Revenue diversification Upon completion of this project, how will you achieve the goals selected above?*Do you have any supporting documents that you would like to attach to this proposal? Business Plan Business Model Canvas/Lean Canvas Financial Projections Market Research Other None If Other, please specify:If you have identified additional information or supporting documentation that you would like to include with this application, please send as an attachment below: Drop files here or Accepted file types: jpg, gif, png, pdf, docx. Company ContributionsHow many hours per week could your company dedicate to partnering on this project?*None1-2 hours per week3-5 hours per week6-10 hours per week11+ hours per weekCan your company contribute materials or supplies to the project?*YESNOCan your company contribute cash to the project budget?*YESNODescribe any other resources your company would be able to commit to the project e.g. use of facilities or equipment*Describe investments, cash and time, in this project to date: Company:Government grants:Venture Capital:Angel Capital:Other:How did you hear about Niagara College Research & Innovation?*PhoneThis field is for validation purposes and should be left unchanged. Partnership Application was last modified: November 18th, 2016 by cms007ad
