Incubator Client Information Form
Date:
1/1/2017
This Survey has been deactivated
Lease Information:
Principal on Lease (Last, First):
Incubator Name:
Incubator Room Numbers:
Incubator Space (sq. ft.):
Current FTEs:
FTEs Anticipated in 12 Months:
Business Information:
Business Name:
Business Type:
Current Student Interns:
Current SUNY Graduate Employees:
Business Description:
hhhh
Technology Description:
ffff
Income Statement:
Amount
2015 Total Revenue:
2015 Total Expenses:
2016 Total Revenue:
2016 Total Expenses:
2017 Total Revenue (Forecast):
2017 Total Expenses (Forecast):
Grants Awarded:
Amount
Source
2013 Grants:
2014 Grants:
2015 Grants:
2016 Grants:
2017 Grants:
2018 Grants:
Employee Hires
(to date)
:
Number
Positions
2013 FTEs:
2014 FTEs:
2015 FTEs:
2016 FTEs:
2017 FTEs (Forecast):
Projected Exit Date:
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
<<
<
April 2024
>
<<
April 2024
S
M
T
W
T
F
S
14
31
1
2
3
4
5
6
15
7
8
9
10
11
12
13
16
14
15
16
17
18
19
20
17
21
22
23
24
25
26
27
18
28
29
30
1
2
3
4
19
5
6
7
8
9
10
11
Equity/Debt Raised:
Amount
Source
2013 Capital Raised:
2014 Capital Raised:
2015 Capital Raised:
2016 Capital Raised:
2017 Capital Raised (Forecast):
Use of University Facilities and Programs (Please check all that apply):
Attended University Workshops/Events
Collaberated with University Faculty
Accessed University Labs/Equipment
Hired University Students
Received SBDC Counseling
Mentored/Collaborated with Other Tenants
Worked with a CAT (Bio, Sensor, Other)
Met with Incubator Advocate
Completed SPIR Project
Negotiated with Licensing and Industry Relations
Top 4 Previous 12 Month Goals/Milestones Met:
1)
2)
3)
4)
Top 4 Projected 12 Month Goals/ Milestones:
1)
2)
3)
4)
Exit Strategy:
Comments: