Research and Innovation Project Request Form

Note: Companies must participate in the project and contribute to its direct cost. Required contributions vary with the size of the company, funding program, scope of the project and size of the grant.

Contact information

Applicant name*

Title

Applicant company

Company address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Website

Phone #*

Applicant email address*

Please specify*

Applicant's phone
Business phone

Business information

Sector*

Number of years in business*

Other Sector*

Based in Ontario?*

yes
no

Based in Canada?*

yes
no

Business incorporated?*

yes
no

Number of T4 employees*

HST # (optional)

Revenue*

$0 - $100k
$100k - $1million
over $1million

Any potential conflict of interest with a Georgian College employee?*

yes
no

Are you a current or former client of the Henry Bernick Entrepreneurship Centre (HBEC) here at Georgian College?*

yes
no

Brief description of business (product and services, markets, etc.)*

Brief project description*

Desired project start date*

Desired project completion date*

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Name

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