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Company Entrepreneur in Residence Interest Form
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Name of Company
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Address
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Contact Information (Phone, Email):
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Number of full time employees:
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What is your company trying to accomplish?
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Please share your executive summary:
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Briefly describe what assistance you are looking for from an Entrepreneur in Residence:
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Do you identify as any of the following?
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Female
Veteran
Hispanic
Asian-Indian
Asian-Pacific American
Black/African American
Native American
Disabled or Neurodiverse
LGBTQA+
Distressed Rural
None of the above
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