Queen's Partnerships & Innovation Intake Form

Thank you for reaching out to the Queen's University Partnerships and Innovation (P&I).

Please answer the following questions which will help us to triage and respond to your inquiry within 5 business days.

What is your name? *

What is your email address? *

Please choose the options that best describes you: (Choose all that apply) *

Affiliated with a company that is interested in developing a relationship with Queen's

Affiliated with other external organization

Affiliated with Queen's University

What is the name of your company?
(or other external organization) *

What is your website url? *

Tell us, briefly, the mission of your organization: *

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Where is the company headquartered? *

Does the company have operations in Canada? *

Yes

No

Where is the company's primary location in Canada? *

Does the company do or wish to do R&D? *

Yes

No

Does the company do or wish to do R&D in Canada? *

Yes

No

Does your company have a current or past relationship with the National Research Council - Industrial Research Assistance Program (NRC-IRAP)? *

Yes

No

What is your role within the company? *

What is your affiliation with Queen's University?: *

Are you a QUFA member? *

Yes

No

Are you a clinician? *

Yes

No

Are you cross appointed to Queen's? *

Yes

No

What is your home institution? *

Are you an adjunct faculty member? *

Yes

No

With which Queen's dept. are you affiliated (primary appointment)? *

Are you interested in learning about Queen's OPI partnership development services? *

Yes

No

Are you interested in learning about Queen's OPI legal and research contract services? *

Yes

No

Are you interested in learning about Queen's OPI support for knowledge mobilization and-or commercialization of your research? *

Yes

No

Do you have an invention to disclose? *

Yes

No

With which Queen's dept. are you affiliated (primary appointment)? *

In which Faculty, dept. or program are you registered? *

Please indicate which level: *

Undergraduate

Graduate

Who is (are) your supervisor(s) at Queen's?

1. *

2.

Please indicate which level: *

Masters

PhD

Are you interested in discussing inventions and other intellectual property with Queen's OPI? *

Yes

No

In which dept. are you employed? *

Are you interested in developing a collaboration project with Queen's? *

Yes

No

Are you interested in hiring students from Queen's? *

Yes

No

Are you interested in learning about Queen's programs and services for entrepreneurs, startups and SMEs in Eastern Ontario? *

Yes

No

Have you started a company? *

Yes

No

What is the name of your company? *

Is your company incorporated? *

Yes

No

What year was your company Incorporated? *

Are you a founder of this company? *

Yes

No

How many cofounders do you have? *

How many employees do you have? *

Does your company have annual revenue? *

Yes

No

Does your company do or wish to do R&D? *

Yes

No

Tell us about your objectives related to your interest in learning about Queen's programs for Partnerships and Innovation. *