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Program Application Form - Request for Info from Entrepreneurs, Startups or SMEs


Thank you for reaching out to Queen's Partnerships and Innovation (QPI).


You are interested in applying to Queen's programs and services for entrepreneurs, startups and SMEs in Eastern Ontario.


Please answer the following questions which will help us to determine your company's eligibility for our various programs and services.


Upon submission, we will review your application and if we have any questions we will contact you within 7-10 days of receiving your submission. Please allow 2 weeks for a formal response.


If you have any questions about this application please do not hesitate to contact:


Rick Boswell

boswellr@queensu.ca

 


About You

Contact Info





Address
Please provide the address that your company is working from. For example, use your home address if that is normally where you run your company from, or use the address of the place where your company might lease, rent or work from if different from your home address.






Queen's Affiliation (Not required for program eligibility)

Do you have a relationship with Queen's University? If so, please tell us how you are related to Queen's. This information is NOT used to determine whether you are eligible for the program.

(Please check all that apply)

About Your Company

Description of Your Company







(If not, we will refer to your business by your name and then we will assign your business a reference number that will be used for reporting purposes)







Financial/Markets

Revenue & Funding





Markets

Company Location


Headquarter Address 
Please provide the address of the company's headquarters (as documented in its articles of incorporation):







Primary Base of Operations 
Please provide the address of the company's primary base of operations







Founders/Owners


Check all that apply

(ex Founder, Co-Founder, CEO, President, Principal, etc)



If you have any additional Co-Founders, Partners or Team members that are not exclusively employees of your company, please check YES. A panel will open that will allow you to provide us with information on this/these person/persons.


Additional Founders/Owners/Partners/Team Members


Contact Info





Company Role

Check all that apply

(ex Founder, Co-Founder, CEO, President, Principal, etc)

Queen's Affiliation (Not required for program eligibility)
 

Does this person have a relationship with Queen's University? If so, please tell us how this person is related to Queen's. This information is NOT used to determine whether you are eligible for the program.

(Please check all that apply)


IP / Go To Market Strategy

Intellectual Property




Go To Market



Programs and Services



Goals
Please list up to 3 goals that you would like your company to achieve in the next 6-12 months?









Sustainable Development Goals

Queen's University supports the United Nations Sustainability Development Goals - 17 goals that are a collection of independent but interconnected goals carefully designed to give all of us on our planet a better future. Please select any of the goals listed below that are a core objective in your venture.

You can learn more about these goals by going UN Sustainable Development Goals Section There are many materials available that discuss the goals and how business can participate and be a part of attaining these goals. An example of this can be found at Business For Good (QPI is not affiliated with BIGI).

Additional Information

By submitting this application on behalf of the company named herein, the applicant hereby agrees that if this application is successful the company shall participate in all programs and services, when recommended by QPI, including acceleration programs (depending on space and eligibility), workshops, networking events, etc. 

Privacy

Privacy and Personal Information



Queen's University collects personal information under the authority of the Royal Charter of Queen's University and in accordance with Ontario’s Freedom of Information and Protection of Privacy Act (FIPPA). Queen’s University collects only the personal information which is necessary for it to administer its programs and activities and carry out its services and functions . The personal information is used by employees of the University who need the information to carry out their duties for the purposes for which it was collected or for a consistent purpose. Personal information is retained only as long as is necessary for the fulfillment of the purposes for which it is collected. The University has in place mechanisms to protect the security of the personal information it collects.


What is Personal Information?



'Personal Information' is defined in FIPPA as recorded information about an identifiable individual. An individual's personal information includes information regarding his or her race, gender, home address, medical history, education history, identifying numbers (e.g. SIN, employee number, student number, etc.), financial or employment information, personal opinions, completed assignments and exams, and grades, comments and evaluations provided by an instructor.


If you have a concern about the collection, use or disclosure of your personal information at Queen's University, please contact the Chief Privacy Officer, Carolyn Heald at access.privacy@queensu.ca.