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Ag application form
Snow Conrad
2019-08-29T19:47:46+00:00
AG – Innovation Accelerator
Company Legal Name
*
Operating as (if applicable)
Company Address
Street Number
*
Street Name
*
Unit Number
City
*
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Northwest Territories
Nunavut
Yukon
Postal Code
*
Company Phone Number
*
Company Website
*
Yes
No
Website Address
Co-Space Interest
Social Enterprise
B Corporation or Benefit Corporation
Primary Contact
First Name
*
Last Name
*
Position Title
*
Direct Phone Number
*
Mobile
E-mail
*
Your LinkedIN Address
Alternate Contact
First Name
Last Name
Position Title
Phone Number
Mobile
E-mail
Social Media
Social Media
*
Yes
No
Twitter Address
Facebook Address
Company LinkedIn Address
Corporate Information
Is your company female owned or led?
*
Yes
No
Female Designation
Founder
Co-founder
Owner
C-level executive
Is your company youth-owned or led (under 30)?
Yes
No
Youth Designation
Founder
Co-founder
Owner
C-level executive
Is your Company Incorporated?
*
Yes
No
If Applicable, what is your 9-digit CRA/Business Number?
*
What is the date of incorporation?
Date Format: MM slash DD slash YYYY
Incorporation Jurisdiction
Federally Incorporated
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nunavut
Nova Scotia
Ontario
Prince Edward Island
Quebec
Yukon
Incorporated in Canada or Ontario
Fiscal Year-End Month
January
February
March
April
May
June
July
August
September
October
November
December
Traction - Total Employees (Including Owner/Founder)
Date
*
Date Format: MM slash DD slash YYYY
How many full-time employees?
*
How many part-time employees?
*
In 30 words or less, give a brief description of your company
*
Do you sell primarily products or services?
Product
Service
Both
Traction - Investment
Date
Investment Type
Currency
Investment Amount
Bank Loan
Angel Investment
Venture Capital
Government funding/grants
Personal(self)
Private (including friends&family)
Strategic Partner
Other
CAD
USD
Traction - Intellectual Property
Date
Ip Type
Trademark
Copyright
Trade secrets/recipes
Patents
Other
Traction - Total Revenue
Date
*
Date Format: MM slash DD slash YYYY
What was the company’s Annual Revenue of your most recent tax year
*
Before Expenses in the most recent completed fiscal year
Year over Year “REVENUE’ growth
*
Not applicable
Less than 25%
25 to 50%
Over 50%
Traction - Stage
Please select the industry/sector of your business
*
Agricultural Technology
Food and Beverage
Forestry
Mining
Financial Services
Education
Digital Media and ICT
Clean Technologies
Advanced Materials and Manufacturing
Life Science and Advanced Health
Tourism and Culture
Other
If Other
*
What is your company’s primary focus?
*
Biological Agriculture
Agriculture IT
Agriculture Producers
Agriculture Other
Agriculture - Other
What is your company’s primary focus?
*
Food and Beverage IT
Food and Beverage, processors
Food and Beverage Other
Food and Beverage - Other
What is your company’s primary focus?
*
Forestry IT
Forestry Other
Forestry - Other
What is your company’s primary focus?
*
Mining IT
Mining Other
Mining Other
What is your company’s primary focus?
*
Financial Services IT
Financial Services Other
Financial Services - Other
What is your company’s primary focus?
*
Education IT
Education Other
Education Other
What is your company’s primary focus?
*
Apps and Software
Hardware
Other
Digital - Other
What is your company’s primary focus?
*
Water Technologies
Recycling and Waste Management
Energy and Power Technologies
Clean Technologies Other
Clean Technologies - Other
What is your company’s primary focus?
*
Materials and Chemicals
Manufactured Goods
Manufacturing Processes
Advanced Materials and Manufacturing Other
Advanced Materials and Manufacturing - Other
What is your company’s primary focus?
*
Pharmaceuticals and Drugs
Medical Devices
Healthcare IT
Wellness & Nutrition
Life Science and Advanced Health Other
Life Science and Advanced Health
What is your company’s primary focus?
*
Tourism and Culture IT
Tourism and Culture Other
Tourism and Culture - Other
What is your target geographic market?
*
Local
Provincial
National
International
Please describe your product or service
*
Do you currently export?
*
Yes
No
Describe your ideal/target customer
*
List the countries/regions
Program Specific Information
Program Type
Describe the specific consulting services that would be of greatest benefit to your company
Closing Information
Date
Date Format: MM slash DD slash YYYY
Are you working with any other Innovation Centres
Yes
No
If Yes
*
Communitech (Kitchener/Waterloo)
HalTech (Halton)
IION - Innovation Initiatives Ontario North (North Bay)
Innovation Factory (Hamilton)
Innovate Niagara (Niagara)
Invest Ottawa (Ottawa)
Launch Lab (Kingston)
MaRS Discovery District (Toronto)
NORCAT / Innovation Mill - Northern Centre for Advanced Technology (Sudbury)
NWOIC - Northwestern Ontario Innovation Centre (Thunder Bay)
RIC Centre (Mississauga)
Spark Centre (Whitby)
SSMIC - Sault Ste. Marie Innovation Centre (Sault Ste. Marie)
TechAlliance of Southwestern Ontario (London)
VentureLAB (Markham)
WEtech Alliance (Windsor)
How did you hear about Innovation Guelph
*
IG Event/Staff
Social Media
Web Search
Conference/Trade show
Direct Referral
Other
If Direct Referral
Ontario Centres of Excellence (OCE)
University of Guelph
Conestoga College
Other Regional Innovation Centre
City of Guelph
Guelph Chamber of Commerce
Wellington County
Business Centre Guelph Wellington
NRC-IRAP
Financial Institution
If Other
*
I acknowledge that I have read and agree to the Client Services Agreement which will come in to effect if I am accepted into any Innovation Guelph program (embedded link)
I would like to receive email communications from Innovation Guelph (e.g. newsletter) regardless of the outcome of this application
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