MIC Application

Applicant Information

First Name (required)

Last Name (required)

Title (required)

Phone Number (required)

Email (required)

Company (required)

Street Address (required)

Street Address

City (required)

State (required)

Zip Code

Website

How would locating to the Mānoa Innovation Center help your company?

Program

Offices are reserved for tech startups and companies that provide support for the incubation program.
Office space for Tech StartupOffice space for otherVirtual (co-working)

If you selected "Office space for other", please explain how your company qualifies.

Project/Business Information

Provide a brief description of your business suitable for publication. UH may use this information in promotional material.

Stage in Development
Pre-prototypeProduct DevelopmentProduct LaunchCommercializationRevenue Generating

Current status of technology

What is the end product?

Current annual revenue:

Have you participated in an Accelerator?
YesNo

Product/Market/Approach (max file size 5 MB)

How do you plan to take the product to market?

A brief description of the idea, product or service

Market opportunity - Potential size in dollars

Potential size in number of users

A brief description of Problem/Pain-points you are solving

How is your technology new, emerging, or disruptive? Describe your value proposition

Employees

Full Time Part Time
Current number
Projected number

Financials

Current Year Financial Statements (max file size 10 MB)

If none are available, please explain

Business Bank

Type of financing to date
Personal resourcesPrivate InvestorsGovernment Loans/GrantsFriends & FamilyOther

If Other, please describe

Will the business require additional financing to get a product to market? Explain plans to obtain funding and how much money is needed.

Pro Forma Projections (max file size 5 MB)

If not available, please explain

Business Structure

Date business established

Please specify your business type
Sole ProprietorshipS CorporationC CorporationLimited Liability CompanyLimited Liability PartnershipLimited PartnershipGeneral PartnershipOther

If Other, please describe

Country of Incorporation

Are you registered to do business in Hawaiʻi? This is a requirement to be considered for tenancy.
YesNo

Facility Needs

Approximate date you wish to move in or be a virtual tenant

Space requirements
Requested square feet

Min square feet Max square feet

Special facility requirements (electrical, ventilation, floor load, etc.)

List any unusual equipment used in operation

Applicant understands that the information provided in this application will be used for evaluation purposes by the University of Hawaiʻi (UH), its representatives and its agents. If any portion of the information is confidential, applicant must inform UH.

Agreement to Indemnify and Defend
Applicant's company has requested services from UH.

Applicant agrees to provide the UH staff, representatives, agents, and associates with current financial and operating data, and to satisfy such other reasonable requests for information about his/her company in order for UH to determine whether to grant applicant tenancy in the building or as a virtual tenant.

Applicant acknowledges that its claims or demands for loss or damages against UH, its officers, employees, agents, or any person acting on their behalf such as independent contractors and/or consultants, including but not limited to claims or demands for loss or damages based upon the alleged negligence of UH may be limited by statutory immunities provided by law to the university.

Further, applicant and his/her company will defend, indemnify, and hold harmless UH, State of Hawaiʻi, and their officers, employees, agents, or any person acting on their behalf such as independent contractors and/or consultants, from any and all third-party claims and demands for loss or damages arising from the submission, evaluation, and the disposition of this tenant application.

By submitting this agreement, applicant certifies that he/she is authorized by the company listed below to act as its agent and that he/she is authorized to sign this indemnity agreement on behalf of that company and to legally bind that company to the terms of this Agreement.

Applicant hereby certifies that to the best of his/her knowledge all the information herewith contained is true and accurate. Applicant also certifies that any statements made that knowingly misrepresents the facts will result in the denial of his/her application for assistance and occupancy.