INTAKE FORM

To begin the process, please fill out the Empire Corps Intake Form.

After submission, the Empire Corps Operations Manager will email you a Calendly link to schedule a 30-minute Zoom Introduction and Assessment Meeting. Following this, the company will be reviewed by the Empire Corps Advisory Committee. If accepted, the company will be assigned two Empire Corps Mentors who will provide guidance throughout the ventures SBIR/STTR journey.

First Name*

Last name*

Position/Role in Company

Phone*

Email*

Company Name

Company NYS Registered Address

City

State*

Zip / Postal Code

Company Website

What is your UEI # status?*

Registered

Applied & Pending

Need help with Registration

Unsure

Please provide a brief description of your technology/product/service. *

What TRL level do you believe your technology is at? *

2-3

4-5

6-7

8-9

Unsure

TRL Levels defined: https://www.dst.defence.gov.au/sites/default/files/basic_pages/documents/TRL%20Explanations_1.pdf

Have you ever participated in a I-Corps program (regionally or nationally)? *

Yes

Have you ever participated in a NY-based accelerator or entrepreneurship training program?*

Yes

What is your current SBIR/ STTR status?*

What is an SBIR/STTR?

Never Applied

Previously Applied & Not Awarded

Previously Applied & Awarded

Feel free to include additional information regarding your support needs.

How did you learn about Empire Corps?*

NY I-Corps Hub / NYC Innovation Hot Spot

Referral

Workshop

Other Event

Google

Other

CUNY Industrial and Applied Research

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