Incubator Intake Assessment

Incubator Intake Assessment

Name: ______Company: ______

Title: ______Date: ______

Address: ______City: ______State: ______Zip: ______

Primary Telephone #: ______E-Mail: ______

How did you hear of the Food Innovation Center: ______

This survey will assist the Center in assessing the services you require and determining the potential for positive impact in guiding you through the appropriate process. Please answer these questions to the best of your ability.

The information requested is required for aggregate statistical reporting purposes and shall otherwise be treated as business confidential.

Please describe your product:

______

Describe your goal, vision, and anticipated growth for the future of your business:

______

Why are you seeking production resources at the Food Innovation Center business incubator facility (such as: market testing of new product concept; new product launch; new technologies to be tested; need for USDA, FDA, organic and/or kosher certified facility)

______

Part I: Process Required:

Please select the process required for your product (select all that applies)

Hot Process (Beverage, Sauce, Jam/Jelly, Soup, Stew, Hot-Fill Entrée, etc.)

If hot process: What is the required minimum temperature______

If hot process: What is the required holding time______

Dry Process (Baked Pies, Breads, etc.; Dehydrated Products; Dry Mixed Snacks, etc.)

Cold Process (Fresh-Cut Fruits and Vegetables and Salad Mixes)

Cold Assembly (Need for product packaging in a refrigerated “Clean Room”)

Has the product and process been reviewed by a processing authority?

Yes (If so, please attach documentation) No

The incubator facility will be FDA inspected and meet local and state health inspection requirements. Do you require any additional processing considerations?

Kosher Organic USDA

Allergen-free Others______

What type of equipment is required for your product process (e.g., type and sizes of kettles, ovens, fillers, etc. that will be needed)?

______

Please briefly describe your production Processes?

______

Part II: Packaging:

Type of Container Needed (check all that are appropriate):

Rigid Plastic Glass Pouch or Bag Shrink Wrap

Tray Other(s)______

What type of equipment is required for your packaging process (e.g., labeling equipment, type and size of vacuum packing equipment, horizontal or vertical form-fill-seal equipment, shrink wrap needs, Tipper Tie, etc.)

______

What is the fill weight/unit for your product(s)? ______

How many units of your product are packaged per case? ______

Is your label:

Multi-color and Preprinted Can be printed in black and white on site

Other labeling requirements ______

Please describe your code dating requirements and locations on the unit/case where this is required:

______

Part III: Labor:

Would you prefer to manufacture your products at Food Innovation Center using:

Own staff FIC staff Other______

Part IV: Estimated storage requirements:

What is the expected frequency of your production?

Weekly Twice a month Monthly Semi-Annually

Yearly Seasonally Other______

Please indicate the type(s) and amount(s) of storage needed for your raw material(s):

Ambient______Frozen______Refrigerated______

Please indicate the type(s) and amount(s) of storage needed for your finished product(s):

Ambient______Frozen______Refrigerated______

When is your desired start date? ______

Are there any special shipping and receiving requirements?

______

What is your expected production volume requirement(s) for the next twelve months?

______

Do you have a food retail license? Yes No

Do you have a wholesale license? Yes No

Do you have liability Insurance? Yes No

Please indicated other services of the Food Innovation Center that you may be interested in? (Check all that applies)

Sensory Product Development Micro Testing

Focus Group Others______

Part III: Required Statistical Information: The information requested is required for aggregate statistical reporting purposes and shall otherwise be treated as business confidential.

Women Owned (>50%) Business: ¨ Yes ¨ No

Minority Owned Business: ¨ Yes ¨ No

Are you: ¨ Asian Pacific American ¨ Black American ¨ Caucasian ¨ Hispanic American ¨ Native American ¨ Other______¨ Subcontinent Asian American

Please indicate the current number of employees: _____ Full Time (Include Owners)

_____ Part Time

Please provide your approximate current gross annual revenue ($): ______

● By what percent has your revenue increased or decreased from the previous year: ______%

● What percent of your current revenue is from external funding sources: _____%

Consider the following sources as external funding sources:

● Investors ● Grants ● Loans ● Angel funding

Please provide your approximate current annual expense ($): ______

Consider the following categories in your expenses:

● Salaries ● Supplies ● Equipment ● R&D ● Technical Svc ● Ingredients

● Packaging ● Distribution ● Rent (space) ● Storage ● Utilities

● Legal ● Permit fees ● Patent fees ● Marketing ● Insurance

● Approximately what percent of your current expense is payroll: _____%