NEX-LABS Incubation Voucher | Application Form
Please take the take to thoughroughly fill in the application form below.
Applicant Information
Name
*
First Name
Last Name
Gender
*
Please Select
Male
Female
Non-binary
Date of birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
-
Country Code
-
Area Code
Phone Number
LinkedIn Account
*
Highest Level of Education
*
Please Select
Less than secondary School
High School
Professional Technician's Diploma
Higher Technician's Diploma
Bachelor's degree
Masters
PhD
Education Field
*
Total years of experience
*
Are you currently employed?
*
Yes
No
Current employer
*
Current position
*
Startup Information
Project name
*
Physical Address
*
Street Address
Street Address Line 2
City
Postal / Zip Code
Number of employees/team members
*
Year of project start
*
Stage
*
Pre-seed
Early-stage
Growth-stage
Other
Is the project/startup registered?
*
Yes
No
Project/startup brief description
*
What is unique about your project/startup?
*
Brief list of the different products/services your project/startups currently provides
*
Products/Services Information
Product name
*
Fields of your product (multiple options)
*
Water
Energy
Food
When did you start developing this product/service? (year)
*
Stage
*
Concept
Prototype
Pilot production
Already marketed
Other
Brief description of product
*
What is unique about your product/service?
*
Why is this product/service strategically important to your project/startup?
*
If applicable, describe how your product exploits efficiencies between water, energy and food (for example, uses water to produce vegetables)?
Short-Term Goals
Should you qualify, what do you hope to achieve within the 6-months of incubation?
*
Impact
If applicable, explain the impact of being incubated at yourability to bring your technology to the market.
If applicable, explain the impact of being incubated at your ability to bring your technology to attract investment.
If applicable, explain the impact of being incubated at your ability to bring your technology to form new partnerships.
If applicable, explain the impact of being incubated at your ability to bring your technology to export your product.
Thank you for taking the time to fill in the NEXUS Incubation Voucher application form.
You will be contacted once the application is reviewed and the selection process is achieved.
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