• Tenant/Client Intake Contact: techinnovationlab@uic.edu 

  • NOTE: Primary contact must be allowed to sign for the company. For University employees, please provide an appropriate email for commercial activities.

  • Affiliation Identify, Faculty, Staff or Student affiliation with the University of Illinois System. List institution/company in "other" if not UI affiliated.*

  • Intellectual Property Source Indicate if the IP was generated at UI or list other research institution, laboratory or company.*

  • Conflict Management Plan Indicate if all key people have completed a conflict management plan with respective employers.*
  • Technology Sector Mark all that apply*

  • 0/300
  • 0/500
  • 0/300
  • 0/300
  • 0/300
  • 0/300
  • Identify support, services and resources needed. Mark all that apply.*

  • Identify other programs, resources, services used

  • Has new company been formed?*
  • Company Corporate Structure

  • Date of Incorporation
     - -
    2 digit month, 2 digit day, 4 digit year
  • Is your company in good standing with the State of Illinois?
  • Identify space and equipment needs

  • Material Usage Mark all that apply.*

  • NOTE: NOT ALL LISTED MATERIALS ARE PERMITTED IN ENTERPRISEWORKS CHICAGO FACILITIES.
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  • By hitting the submit button, I agree that all information provided is accurate and true to the best of my knowledge.

  • Should be Empty: