<p> For office use only</p><p>Application for Incubator Space </p><p>Thank you for your interest in the Calit2 TechPortal at UCI. We look forward to the possibility of working with you. Given that we typically have more interest than we have space, the following information will be helpful to us in prioritizing the available space. Completed applications can be sent via e-mail [email protected]. In addition to submitting this application, please include a copy of the executive summary submitted with the record of invention to UCI’s Office of Technology Alliances. Contact the Calit2 front desk at 949.824.6900 for additional information or assistance.</p><p>1. Company name and your phone and e-mail contact information: </p><p>2. Please provide an overview of the technology to be worked on at the incubator, the target markets for this technology and commercial viability:</p><p>3. Please list the names of UCI inventors of the technology to be further developed at the incubator (including the UCI case numbers for the inventions, if known) and summarize the current status of any licensing discussions underway with UCI for the intellectual property rights (note that it is a requirement that the proposed project be based on UCI intellectual property): </p><p>4. Please summarize the current funding status of your company (e.g. “friends and family” investors, angel investors, VC funding, etc.) and total amount of current working capital (note that the company must have initial seed capital in order to locate at the incubator) as well as the bios of any business people working with the company (you may attach bios separately): </p><p>5. Please provide a list of the key technology development milestones to be worked on at the incubator and an anticipated timeline to achieve each of these milestones. </p><p>6. Describe any planned or ongoing collaborations with UCI professors and labs/centers that your company currently has for this technology: </p><p>7. Please estimate how many people you will have working at the incubator, and list any instrumentation and hardware you are planning to bring in to your space at the incubator: </p><p>8. Please list which, if any, of the UCI recharge facilities made available to you as a TechPortal tenant that you intend to use (a list of these recharge facilities is available at): http://www.calit2.uci.edu/calit2-techportal/default.aspx?cguid=497D1755-E6BF-4DBD-A855-D9A00B493BC9</p><p>9. If your application is approved, when would you like to move into the space:</p><p>10. Any other points you would like the committee to consider (remember your application must include a copy of the executive summary submitted with the record of invention to UCI’s Office of Technology Alliances): </p>