J-1 Visa International Innovation Program (IIP)
EastStroudsburgUniversityofPennsylvania
ResearchandEconomicDevelopment
J-1 Visa International Innovation Program (IIP)
BusinessAccelerator Application
International Company – US Entry Strategy Stage
Before answering, please visit
A. Questions Pertaining to U.Ss Project / Company (Part I)No. / Question / Your Response
1 / Company name
2 / Industry / Sector
3 / Address of foreign parent company / Address:
Country:
4 / Website
5 / Phone number
6 / Fax number
7 / Global Gross revenue (USD)
7a / Total Export sales (USD)
7b / U.S. Gross revenue (USD) – if any
8 / Do you hold proprietary rights (patents/licenses) for the technology you are developing? Do you have the trademarks? / Proprietary Rights
______Yes
______No
Details:
Trademarks
______Yes
______No
9 / Is your venture incorporated in the USA? If No, go to No. 11 / ____Yes
_____No
9a / If Yes, date established, and state
9b / Corporate U.S. Address – if there are multiple entities in the U.S. please list all.
9c / Type of business formation – e.g. corporation, LLC, partnership, branch/liaison office, sole proprietorship, joint venture, subsidiary.
10 / If applicable, Federal Employer Identification Number (EIN)
11 / Name, title and contact information of person in the United States signing forms on behalf of the Company.
A. Questions Pertaining to US Project / Company (part II)
No. / Question / Your Response
12 / Please describe products/services that your company supplies
13 / What are your competitive advantages?
14 / List the countries where your products/services are sold
15 / Describe your channels of distribution (direct sales, sales agents, distributors, integrators, other) / In your home country and internationally
16 / Describe your target market(s) and customers
17 / List your main current clients
18 / Please list your main competitors in the United States
19 / Describe your Sales/Marketing Strategy to enter the American Market
20 / Additional Information (business plan, comments, …)
B. Questions Pertaining to the investment in the United States
No. / Question / Your Response
1 / Please provide a 3-year forecast of your revenues and expenses in the United States
2 / Have you secured any of the following to capitalize your U.S. development to date? / - Government grant/contract: ____Yes _____No
Amount: $______USD
- Angel investment: _____Yes ______No
Amount: $______USD
- Venture capital: ______Yes ______No
Amount: $______USD
- Corporate partner investments: ______Yes ______No
Amount: $______USD
- Self funded: ______Yes ______No
Amount: $______USD
- Other Sources of funding: _____Yes _____No
Amount: $______USD
Details: ______
3 / How will you fund your operations for the first year? (i.e. cash reserves, credit cards, investment, operating revenue, bank loan, grant, etc.)
4 / Are you looking for more sources of funding? / ______Yes
______No
4a / If yes, please indicate / Amount: $______USD
Time frame:
C. Questions Pertaining to the Employees
No. / Question / Your Response
1 / Total number of current U.S. employees, names and contact information (if applicable)
2 / Name of the Foreign National pre-qualified for ESU J-1 classification (maximum 3 persons) / Name:
Email address:
Cell phone number:
Position:
3 / Please insert number of employee you expect in the United States / Managerial Executives / Specialized Essential / All other Employees
This Year (N) / N+1 / N+2 / This Year (N) / N+1 / N+2 / This Year (N) / N+1 / N+2
TOTAL
D. Questions Pertaining to ESU Business Accelerator Services
No. / Question / Your Response
1 / What type of space do you need in the Business Accelerator? / _____Office______Wet Lab
1a / Approximately how much space will you need? / In square feet or number of desks
2 / When do you anticipate needing the space? / (mm/ yyyy)
3 / If you will be conducting research or manufacturing operations that require the use of any chemicals, please list them. / Name of Chemical 1:
Name of Chemical 2:
Name of Chemical 3:
4 / Which of the following resources would benefit your company? / Accounting: ______Yes ______No
Legal: ______Yes ______No
Financial: ______Yes ______No
Production: ______Yes ______No
Marketing: ______Yes ______No
Technical: ______Yes ______No
Management: ______Yes ______No
Intellectual Property: ______Yes _____No
Other (precise):
5 / Are you interested in utilizing student interns or graduate assistants? If so, in what capacity and when? / ______Yes ______No
Number: ______
Date: (mm/yyyy)
Details:
6 / Do you have an existing relationship with ESU’s faculty, staff, students or programs?
If so, describe.
7 / How did you hear about the ESU Business Accelerator Program?
8 / Will you require accommodations due to a disability? / ______Yes
______No
E. Evidencing U.S. Business and Investment (Checklist)
Please provide the following documentation
No. / Question / Description of attached documentation
1 / Corporate organizational chart (if applicable)
2 / Promotional material (brochure, video, … if applicable)
3 / The Business Accelerator Guidelines signed
4 / This Business Accelerator Application completed and signed
5 / Business plan (if available)
6 / 3-year forecast of your Revenues and Expenses in the United States
7 / Misc. – Please list any additional document you are providing.
Mysignaturebelowcertifiesthatalloftheinformation containedinthisapplicationistrue andcomplete. IauthorizetheESUBusinessAcceleratorProgramtoverifythe information contained inthis application. I understand thatthis application, when submitted, becomestheproperty oftheESUBusiness AcceleratorProgramandwillbe retainedbytheESUResearchandEconomic DevelopmentDivisionwhetherornotthe applicationisapproved.
Signature: Date:
Name(Print): Title:
TosubmitthisApplication:
•Pleasesubmit the form via email at .
•Ormail thecompleted application to:
Director
Business Acceleratorand Entrepreneurship
East Stroudsburg University
Innovation Center
562 Independence Road
East Stroudsburg, PA18301
USA