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.