Expression Of Interest Form

UCC/Tyndall Incubation Centre

(Bio-Transfer Unit, Tyndall Prospect Centre and IT Incubation Centre)

Expression of Interest Application Form

Important

All information provided below will be treated with complete confidentiality and will not be disclosed to parties other than those directly involved in the application and review process

1. Contact Details

Contact Person:
Position Held:
Business or Company Name:
Address:
CEO (if applicable)
Telephone: / Fax:
Email:
Website:

2. Business Status

(i)  Present Employment

(ii)  Please indicate if you are operating under any of the following:

Sole Trader
Partnership
Joint Venture
Limited Company
Other: please indicate

(iii) Are you trading already?

Yes /

No

(iv) Have you already secured funding?

Yes /

No

3. What Life Sciences/IT/ICT Industry Sector are you in?

(i) Please tick any that apply

IT / ICT
Food / Biomedical Devices
Pharma / Health
BioPharma / Bioinformatics
Therapeutics / Genomics
Agricultural Biotech / Proteomics
Diagnostics / Veterinary
Environmental Biotech / Other: please list

(ii) Please tick any that apply

Manufacturing

Services
Other (please specify)

4. Business Idea

Provide a short description (200 words or less) of your business, its history and management structure and the activity you propose to carry out in the Incubation Unit.

5. Please list any Intellectual Property rights you have obtained and their current status

6. Why are you interested in becoming a client of the UCC Incubation Unit?

(100 words or less)

7. Please indicate your space requirements and number of personnel you envisage working in the UCC Incubation Unit

8. Please detail any specialised facilities or utilities you propose to bring into the UCC Incubation Unit.

9. What is your link to University College Cork, if any?

10. Please indicate if you already have any links with Enterprise Ireland

11. Any other relevant information

Signature of Applicant: / Date:
Position Held: