XOR Network Entrepreneur Application | LSU Innovation & Technology Commercialization

*Full Name:

LinkedIn URL:

*Email Address:

*Phone Number:

Current Job Title:

*Permanent Street Address:

City, State, Zip:

*Briefly describe your interest or purpose for applying (should be brief and descriptive):

*Have you ever raised money for a start-up company before? If yes, please provide the information requested below.

YesNo

Startup:

Description of Capital Raised:

*Have you ever been the executive of a start-up company?

YesNo

If yes, please describe your role(s):

*In which industries or technology markets do you have significant experience and knowledge?

*Have you worked with an early stage technology originating from university research?

YesNo

If yes, please describe the technology(ies):

*Do you have experience hiring employees and managing a team?

YesNo

If yes, please describe your experience(s):

*Do you have an affiliation with the Southeast and/or a university in the Southeast XOR?

YesNo

*If yes, please describe your affiliation(s):

What are your expectations for utilizing the Southeast XOR?

*Are you willing and able to play the role of CEO for a start-up?

YesNoPossibly

*Do you have relationships with or a network including investors?

YesNo

If yes, please describe your relationship(s) generally:

*Do you have other business experience that would be relevant and valuable as a Southwest XOR Network Entrepreneur?

YesNo

If yes, please describe your experience: