UML I-Corps Program Application: Special Cohort

I-Corps @ UMass Lowell

Application: Special Cohort at the Materials Research Society Conference in Boston
Name of Project / Venture *
Primary Contact Name*

First NameLast Name
Email*
example@example.com
Your Phone Number

Area CodePhone Number
Your LinkedIn URL
Website - company or other relevant link
Don't worry if you do not have one
Do you have any access requirements you would like us to be aware of?

YesNo
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.
Teammate #1 Name

First NameLast Name
Teammate #1 Email
example@example.com
Teammate #2 Name

First NameLast Name
Teammate #2 Email
example@example.com
Teammate #3 Name

First NameLast Name
Teammate #3 Email
example@example.com
What is your current role? Please check one

Undergraduate studentGraduate studentPostdoctoral associate or fellowResearch ScientistFacultyOther
What is your department/lab/center?
Who is your PI?
Please consider including this program in your personal development plans though your PI. We encourage notification and discussion with your PI.
Are you currently a GEM fellow?

YesNo
One paragraph non-technical description of the technology (3-4 sentences)*

0/200
Is this technology based on university research?

YesNo
Have you been involved in the research?

YesNo
Has an invention disclosure been submitted to your Technology Licensing office?

YesNo
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
Up to $5000 is available for prototyping as a part of the program. Do you plan on requesting prototyping funds?

YesNo
Very briefly describe the prototype and give a ballpark of the funding you will need.
Please briefly describe your participation in any entrepreneurial programs, including competitions, coursework or programs.

0/100
I understand that this program requires virtual and in-person participation including full days at the conference in Boston at the Hynes Auditorium, December 3rd - 5th. I am committed to participating in all required activities. I further understand that costs for conference attendance (including registration, hotel stays, meals and local travel) will be reimbursed in accordance with UMass Lowell policies.

Yes - I understand that this program requires virtual and in-person participation, including full days at the conference in Boston at the Hynes Auditorium, December 3rd - 5thNo - I am not able to commit
By applying to the I-Corps program, you agree to complete periodic data collection efforts that may include surveys and/or interviews: (1) before participating in the program, (2) upon completion of the program, (3) one year after completion of the program, and (4) beyond, if you continue to pursue entrepreneurial activities.

Collected data will remain confidential and is used for program improvement and research purposes only.

If you have questions, feel free to send a note to icorps@uml.edu.
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I-Corps @ UMass Lowell