Apply Form Any question marked with an asterisk (*) is required. Salutation –None–Mr. Ms. Miss Mrs. Dr. The Hon. Other First Name* Last Name* Email Address Phone Title Company Name Company Website Street City State/Province Zip Is this business minority owned? If you checked the box above, to which ethnicity do you identify? –None–African American Native American Latin-American/Hispanic Asian-Indian, Asian-Pacific, Pacific Islander American Is this business woman owned? What industry does your business qualify in?* –None–Additive Manufacturing Advanced Materials – Energy Advanced Materials – Environmental Advanced Materials – Healthcare Advanced Materials – Infrastructure Aerospace and Defense Agricultural Equipment and Engineering Automotive Retail and Services Banking and Financial Services (excluding FinTech) Commercial or Industrial Sensors Construction and Home Improvement Consumer Analytics and Data Services Consumer Products Consumer Software Cybersecurity or Defense Education (excluding EdTech) Electronics and Sensors for Communications Energy – Fuel Cells Energy – Solar Energy – Waste ReductionorConversion Energy – Wind Energy Sensors Energy Storage or Distribution Environmental Services and Equipment Financial Technologies Food Production, Processing, and Safety Food Service and Accommodation Health Sensors Healthcare and Human Services Healthcare IT HR/Staffing Industrial Design or Manufacturing Industrial IOT Insurance Leisure, Entertainment, and Arts Life Science – Consumer Products Media and Publishing Medical – Genomics Medical – Regenerative Medicine Medical – Therapeutics or Pharmaceuticals Medical Devices Medical Diagnostics Microfabrication Oil and Gas Extraction Other Professional or Technical Consulting Prototyping, Modeling, and Simulations Real Estate Retail (excluding Auto) Robotics Situational Awareness and Surveillance Systems Software for Business (excluding Healthcare and FinTech) Transportation and Warehousing Please give us a very brief description of your company. (Limited to 255 characters.) What problem does your product or service solve? Tell us about your existing sales, if applicable. Do you have an existing business plan? –None– Yes No How did you hear about YBI? –None– Email Newsletter Event Online Online Ad: Social Media/Google Advertisement Online Article: News Article Online Search: Searching Online For Business Resources Other Personal Reference Personal Referral: Through Family/Friend Print: Flyers/Handouts/Etc. Print newspaper/magazine Professional Referral: Through Another Organization Radio TV How can YBI help you? (Select one or multiple.) Advisory Services Business Plan Development Capital Access Planning Funding Incubator/Workspace Other How else can the YBI help you? Are you new to the YBI or have you worked with us before? –None– Idea Stage (<1 year) New/Startup (1-2 year(s)) Existing (3-5 years) Established (5+ years) Established – Spin out Technology
