EMIN Enterprise solutions

Enterprise Inc Application Form
Please complete this application form to be considered for funding from the Enterprise Inc Project.

First Name: Surname:

Address: Postcode:

Date of birth:

Phone number: Mobile number: Email address:

Confirm email:

Gender: Male Female

Degree year:

University name:

Course:

Date graduated: (if applicable)

How did you hear about the programme:

Do you require a permit to work in the UK? Yes No

Ethnic group:

Do you consider yourself to have a disability? Yes No

Please write a brief description about the business idea:

Will the business be set up on your own or jointly with others? If with others please state how many and their names.

Describe below what you anticipate the business to achieve during your placement and what support you may require in order to achieve this.

Declaration

I understand that the support will be used solely for business development purposes as indicated in the Proposal below.

I will provide the University Partners with the legal right to investigate expenditure associated with any awards made.

I acknowledge that in some circumstances an award may be made subject my acceptance of special conditions imposed and I further acknowledge that payment may be made subject to my satisfactory completion of milestones and agree to comply with any conditions imposed.

I understand that the method of payment will be at the discretion of the Partner University and any liability for payment will end at the completion of my placement period.

This programme is being part funded by the East Midlands Development Agency and the European Regional Development Fund and by signing this form you are confirming that your business has not received State Aid greater than €500,000 in any rolling 3 year period.

I declare that the details given on this form are true and to the best of my knowledge.

This project is part funded by:

MY EMIN