ACCELERATE APPLICATION

Company form *

S-Corp

Sole Proprietor

C-Corp

LLC

Other

Not Established

Date Established

MM

DD

YYYY

Status of Company *

Start-up

Product Development

Prototype

Full Operation

Are you working on this business full time? *

Yes

No

Financing to Date *

Personal

Venture Capital

Private Investors

Other

Status of Business Plan *

Not Started

Partial

Completed

Primary services requested:

Business Coaching

Investor Readiness

Telecommunications

Facility Space

Strategic Partners/Alliances

Other

Intellectual Property Status *

Patent Pending

Patent

Exclusive License

Copyright

Non-Exclusive License

Copyright Pending

N/A

Applicant hereby acknowledges that its application to and submission of information to the Review Committee of the Innovation Center does not guarantee admission into the accelerate program nor does it create any rights in applicant to future consideration. The Review Committee retains full discretion as to admission into the Program and reserves the right to reject any applicant for any reason.  Applicant hereby waives any right of appeal or legal action against any and all parties associated with the Accelerator, including but not limited to Pinellas County, Pinellas County Industrial Development Authority, Pinellas County Economic Development Authority, The Innovation Center and the member of the Review Committee. All applications will be held in confidence and will be retained in the Review Committee’s files unless otherwise requested in writing by applicant. Applicant agrees to indemnify, defend and hold harmless the Innovation Center, its directors, officers, employees, operator, consultants and any Governmental agencies associated with the Accelerator from any and all claims, actions, causes of action, damages and liabilities asserted against the aforementioned individuals or entities arising out of or in any way connected with the activities and services provided by the Accelerator, including, but not limited to, the provision of space, training or classes. Do you acknowledge that you have read and acknowledge the above disclaimer? *

Yes

No