Expression of Research Interest Form
Company Profile
Company Name
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Company Website
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Afghanistan
Albania
Algeria
American Samoa
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Angola
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Antigua and Barbuda
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Iran
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Jordan
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Laos
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Liberia
Libya
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Madagascar
Malawi
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Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
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Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
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Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
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Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
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Slovakia
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Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
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Tuvalu
Uganda
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Uzbekistan
Vanuatu
Vatican City
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British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
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Other
Country
Phone Number
*
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Area Code
Phone Number
Extension
Primary Contact Name
*
First Name
Last Name
Title
Email
*
example@example.com
Is your company registered in Canada?
*
Yes
No
Since
*
Number of Full-time employees
*
Number of Part-time employees
*
Brief Description of the Company
*
(such as current financial support, key members of management team, products on market, expected time to market entry etc)
Do you have a Research & Development department?
*
No
Yes
Estimated Budget of Research & Development department
Project Description
Project Title
Project Description
*
(including the perceived business opportunity, potential economic development impacts such as jobs created, increased revenues, new markets entered etc)
Desired Project Outcomes
(eg. Prototype built, process developed, market research conducted etc.)
Assistance Required From CRI / Areas of Expertise Required / Equipment and Facilities
Desired Start Date
-
Month
-
Day
Year
Date
Desired End Date
-
Month
-
Day
Year
Date
My business is able to invest a good-faith cash contribution to the project (*CRI will discuss grant and funding opportunities to support your project)
Yes
No
Cash
In-Kind
Attachments
Browse Files
Please attach any supporting documentation (e.g. a pitch deck, product specification sheet, etc.). Documents may be in Word, Excel, PDF, or an image (JPG, GIF, PNG) format.
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