Foster Center for Innovation Business Counseling Form
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Email *
Client Request for Counseling
Client Name (person completing this form/representative of the company) *
Email *
Project Name (if applicable)
Telephone *
Current Address (street, city, state, zip)
Hometown
Month and Year Project Started
Race (mark one or more)
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Ethnicity
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Gender
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Veteran Status
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Military Status
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Names of Other Team Members (Include best contact email)
Type of Project (Choose best category)
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What inspired you to contact us? (Mark best choice)
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I'm currently a UMaine... *
I understand that any information disclosed will be held in strict confidence. I authorize the SIC to furnish relevant information to the assigned management counselor(s). I further understand that the counselor(s) agree not to: 1) recommend goods or services from sources in which they have an interest, and 2) accept fees or commissions developing from this counseling relationship. In consideration of the counselor(s) furnishing management or technical assistance, I waive all claims against the SIC personnel, and that of its Resource Partners and host organizations, arising from this assistance.
Please sign your name and date below. *
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