I-Corps Spark - Southern Maine
Application
Name of Project / Venture
*
Primary Contact Name
*
First Name
Last Name
Email
*
example@example.com
Your Phone Number
-
Area Code
Phone Number
Your LinkedIn URL
Website - company or other relevant link
Don't worry if you do not have one
This course is open to individuals and teams from universities or with other affiliations. Please fill out accordingly. You may enroll as an individual or with one or more team members. If you have additional team members, please list their names and emails below.
Please note that these individuals will be required to attend all meetings and participate fully in the program
Are you currently a student, faculty or researcher at a New England university/college/institution?
*
Yes
No
Please check one
Undergraduate student
Graduate student
Postdoctoral associate or fellow
Research Scientist
Faculty
Other
Are you a practicing clinician?
Yes
No
Other
Please check one (if yes)
Nurse
Physician
Physician assistant
Operations or administration
Other
What is your department/lab/center?
Who is your PI or Supervisor?
Please consider including this program in your personal development plans though your PI. We encourage notification and discussion with your PI.
One paragraph non-technical description of the technology (3-4 sentences)
*
0/200
Is this technology based on university/institution research?
Yes
No
Have you been involved in the research?
Yes
No
Has an invention disclosure been submitted to your Technology Licensing office?
Yes
No
Is there IP? In a few sentences describe the IP status and why you think you will have access to use it or why you expect you can get a license for it
*
0/100
Why do you want to participate in this I-Corps program?
*
0/100
What do you hope to learn?
*
0/100
What outcomes do you hope to achieve?
*
0/100
Please describe your participation in any entrepreneurial programs, including competitions, coursework or programs.
0/100
Comments? Anything else you would like us to know?
0/100
If you have questions, feel free to send a note to
icorps@mit.edu
.
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