Pre-Application Inquiry

Lakeshore Advantage BioBusiness Accelerator at the MSU Bioeconomy Institute, Holland, MI

[Note - this page will soon be modified to permit online submission]

This document is intended to convey the undersigned company’s interest in Lakeshore Advantage’s BioBusiness Accelerator program. This program is available to qualified small-business leaseholders at the Michigan State University Bioeconomy Institute in Holland, MI. Basic company information is requested that will permit Accelerator staff to make a preliminary evaluation of the organization’s conformity to the program’s requirements.

Company Name: ____________________________________________________________________
State of Incorporation: ______________ Type of Organization: _______________________________ __
Number of Employees: _______ Years in Business: _______
Annual Sales: (check one) ___ More than $1M; __ Less Than $1M
Overall stage of Company development: ____________________________________________________
Mailing Address: ______________________________________________________________________
Telephone: ___________________ Alt. Phone: ___________________ Fax: ______________________
Email Address: ______________________________________________________­________________
Primary Contact: ____________________________________ Title: ____________________________
Alt. Contact: _______________________________________ Title: ____________________________
Primary product or service under development:_______________________________________________ __________________________________________________________________________________
Primary market for this product or service: ___________________________________________________ ___________________________________________________________________________________
Space Requirements:___________________________________________________________________
___________________________________________________________________________________
Services Requirements: _________________________________________________________________ ___________________________________________________________________________________

Thank you for your interest in the BioBusiness Accelerator and for taking time to fill out this questionnaire. Following a review of this information, a member of the Accelerator’s staff will contact you to discuss your application and to consider which subsequent steps may be appropriate.

(Information provided herein will be used for vetting purposes only and will be reviewed exclusively by Lakeshore Advantage staff members and affiliated advisors. However, confidential information should not be included in this document.)


This application has been submitted by: ____________________________________________________
Organization Name

___________________________________________________
Authorized Representative

___________________________________________________
Date Submitted