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APPLICATION FOR NEW ENTREPRENEUR FOR TECHNOLOGY INCUBATION PROPOSAL SUBMISSION (CITI/WISE - IIITMK)
Title of the proposal:
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Area of Specialization:
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Brief Description of the Product / Services / Technology business you plan to incubate at CITI/WISE - IIITMK:
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Upload the Business Proposal:
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Number of team members:
Specify your sources of funds:
Specify the name of faculty member of IIITMK you are planning to associate for mentoring and professional support. (Depends upon the availability of the personal)
Suggested Mentor:
Area of Mentoring:
If your proposal gets passed, when will you be going to start it?:
List the clients that have reached you so far:
Indicate the details of members you are planning to associate
Name
Designation
Address
Why do you want to register with CITI/WISE - IIITMK ?:
Infrastructure required:
Hardware or Software required:
(Subject to the availability of institute. Facilities provided - Space, Internet, Furniture, Phone, Stationery, Server, Computer / Laptop)
Name of Team Leader:
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Permanent Address:
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Contact Address
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Contact No:
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Fax:
Email Address:
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Website Address:
Highest Academic Qualification
Area of Specialisation
Academic / Non Academic Acheievements
Name of Institute
Name & Address of Organization
Area of Specialization
Brief Job Description
Experience in any prototype / tools developed by you / team
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