Tenant Application Step 1 of 6 16% The Idaho Innovation Center is a business incubator providing resources to small, fledgling companies where entrepreneurs can confidently and aggressively start and grow their small businesses through collaboration, education, mentoring and shared resources. In order to be eligible for consideration, candidates should meet the following criteria: Have a company registered in the state of Idaho Be a for profit business Be in the early growth stages of business development Have a product or service that can be commercialized within two years The company executive leadership must be located in the incubator (unless affiliate) Have a basic business plan and financial forecast Have a management team in place that can demonstrate an ability to handle both the technical and managerial aspects of the business and is willing to seek and accept assistance from the program and its network of service providers Agree to participate in the incubator’s business education programs and to cooperate in achieving the incubation program’s mission Have the ability to pay deposit and monthly rent or service fee (for affiliate status) and carry up to $1,000,000 liability insurance Be a business well suited to benefit from the program’s services, environment, technical and business expertise Have potential for positive economic impact on the community through: A technology, product or service deemed to have a high potential impact in the marketplace or community Potential for rapid company growth and the associated creation of new high paying jobs Positive impact on the tax base of local and state government Willing to meet quarterly with the Small Business Development Center (SBDC) on business progress. Willing to meet semi annually with the Executive Director for a business review For questions regarding your application or program, please contact Bryan Magleby, Executive Director, at 208-523-1026 or bryan@iictr.com The Application Process is as follows: Applicant submits application to the Idaho Innovation Center The Idaho Innovation Center reviews the application A meeting is set to build rapport, discuss findings, and ask any questions The lease is signed Tenant moves into the Idaho Innovation Center Company Name* Business Type* S Corporation C Corporation Limited Liability Corporation (LLC) Sole Proprietorship Partnership Not in Business Yet Is your business* New Existing If existing, length of time in business* EIN* Registered business name with the State of Idaho Or, DBA Current Business Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone Number*Business Email* What kind of space will you need?* Small Office Large Office Small Garage Bay Large Garage Bay Collaborative Area Check all that apply. Contact Person #1Name* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person #2Name* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I am applying for admission to the Idaho Innovation Center. I understand that the information contained in this application will be held in the strictest confidence by the Idaho Innovation Center staff and Board of Directors. I further understand that this application is subject to review and in no way guarantees my admittance to the Idaho Innovation Center. I agree that the Idaho Innovation Center assumes no responsibility for the success or failure of my business venture. The role of the Idaho Innovation Center is consultative in nature and any advice or information offered may or may not be used at my discretion. Therefore, I release the Idaho Innovation Center and its agents from any liability associated with my business. I would like to be a* Resident Incubator Member (Full time use of incubator space and online access to services) Affiliate Member (Part time use of incubator space and online access to services) Purpose of being a tenant at the Idaho Innovation Center* Business Incubation (up to three (3) years tenancy) Business Innovation (up to five (5) years tenancy) Food Village Please check and describe the business consulting services you will be seeking from the Idaho Innovation Center* Personal Development/Leadership Loan Opportunities/Assistance Bookkeeping/QuickBooks Personal Accountability Organizational Structure Legal Structure Marketing Growth Strategies Financial Controls/Statements Business Modeling/Business Model Canvas Have any owners, officers or directors been convicted of any felony or been disciplined by a body which has issued owner, officer or director a professional license or certification?* Yes No If yes, please explain*Briefly describe business and products or services offered*Describe your long term company goals (5+ years)* Number of full time employeesPrevious Year*Today*One (1) Year Projected*Two (2) Year Projected*Three (3) Year Projected*Number of part time employeesPrevious Year*Today*One (1) Year Projected*Two (2) Year Projected*Three (3) Year Projected*RevenuePrevious Year*Today*One (1) Year Projected*Two (2) Year Projected*Three (3) Year Projected*Special facility requirements (electrical, ventilation, floor load, etc.)Do you have proprietary or intellectual property?* Yes No Is it legally protected (i.e. patent, copyright)?* Yes No Support Services Request Copier/Printer/Fax Postage Machine Mail Box Internet Affiliate Please provide three (3) business referrals and contact informationBusiness* Contact Name* Phone*Email* Business* Contact Name* Phone*Email* Business* Contact Name* Phone*Email* How did you learn about the Idaho Innovation Center?*Required Additional DocumentsSimple business owner/manager resume/work history*Accepted file types: pdf, Max. file size: 5 MB.PDF files less than 5MB accepted.One (1) page business plan or business model canvas*Accepted file types: pdf, Max. file size: 5 MB.PDF files less than 5MB accepted.One (1) page financial projections*Accepted file types: pdf, Max. file size: 5 MB.PDF files less than 5MB accepted. The certify that the above information is true and accurate to the best of my knowledge.Signature* Reset signature Signature locked. Reset to sign again