| 1. |
What is the intended start-up date for your
company? |
| 2. |
Where will the company be located? |
| 3. |
What product(s) or service(s) do you intend to
offer? |
| 4. |
Will you be utilizing University Intellectual
Property(IP)? |
|
If you will be using University IP, you will
you need a license to University technology. Do you want an exclusive or a
non-exclusive license? |
| 5. |
Has a disclosure been filed on this technology?
If so, what are the reference number(s)? |
| 6. |
What organizations have sponsored the research
that lead to your invention(s)? |
| 7. |
Have you developed a business plan? |
| 8. |
Who will be officers and board members in the
company? |
| 9. |
Who are stockholders in your company? |
| 10. |
What will be your role in the company?
(Scientific advisor, CEO, Board Member, President, etc..please specify
all that apply) |
| 11. |
Do you have consulting agreements (past,
present, future) with a sponsor of this research? Please describe. |
| 12. |
Who are investors or potential investors in the
company? |
| 13. |
Are any of the investors or potential investors
employed by any of the sponsors of your research related to this
technology? |
| 14. |
Do you have any consulting arrangements (past,
present, or anticipated) with the company? Please describe. |
| 15. |
Do you plan to use University Resources (space
and/or equipment) for this company? Please describe the nature of the
space and equipment and the access required. |
| 16. |
Will this start up company impact your ability
to publish or do research? If so, please describe the impact. |
| 17. |
What is your financial interest in this start
up company? (stock, stock options, consulting, warrants, consulting, etc.) |
| 18. |
Do you plan to use students to work for your
company? |
| 19. |
If you plan to use students in your start up
company, are they under your direction or from another department? Please
list the students involved. |
| 20. |
Do you plan to use University employees to work
for your company? Please list the involvement of any University employees. |
| 21. |
How will you manage your time commitment to UM
and your presence on campus with this proposed effort? |
