Application Form 2016 Enterprise Ireland Business Partners Programme Explanatory Background: The objective of the EI Business Partners Programme is to identify, qualify and introduce commercially experienced entrepreneurs/individuals to early stage spin-out opportunities within the third level system in Ireland. The goal is to identify individuals with intent and commitment around founding and leading a new spin out company; to achieve that end goal the business partner will be required to use his/her existing commercial skills, experience, contacts network and domain expertise to do e.g. customer discovery and customer development work, advance the minimum viable product towards product/market fit, validate the market opportunity, establish the true product/service value proposition, optimise the business model and seek and secure external equity investment as appropriate. In terms of founding team formation, the expectation is that the business partner will be the major catalyst in bringing a committed founding team together around the spin out opportunity and will lead the team as the founding CEO, with other founders taking up other complementary founding roles as required. When complete, please send this form, along with a brief CV, to: BusinessPartners@enterprise-ireland.com Individual Details: Name: Postal Address: Mobile phone number: Email address: LinkedIn profile: Date of application: If applying via an higher education institution founders programme, please identify which institute: Who is your key contact in that institute? Commercial Experience What commercial experience and domain expertise do you bring to validating and exploiting a business opportunity based on your professional experience to date? Please describe. Intent Please outline your primary intent in getting involved in the programme. Why is the programme a good personal fit with you and why now? If you find a suitable project/spin out opportunity what kind of flexibility do you have in terms of your time commitment? What other calls are there on your time at present – and can they vary if you find the right opportunity through this programme? Investment and Finance Can you give an example where you were centrally involved in a team that raised external equity finance in a start-up company? Or where you were key to pitching and winning budget/funds for a new product development or new product introduction within a corporate environment? Please describe. Do you have contacts in the investor community? If so, can you give examples of national/international investor contacts you have that could be leveraged to raise early stage seed funding? Leadership skills Can you give specific examples of where you were involved in leading a start-up or corporate team and bringing them together around a common business objective – describe what companies/start-ups you worked with and the challenges you faced and how the team overcame those challenges? Please supply details of two referees: Reference 1: Name: Current position/role: Mobile phone number: Email address: LinkedIn profile: Reference 2: Name: Current position/role Mobile phone number: Email address: LinkedIn profile: Enterprise will not contact these references without contacting you first to seek your advance permission. Declaration by applicant: I confirm that: I have a current tax clearance certificate I have not been convicted of an offence (other than road traffic offences) in the last 10 years. I have not had a court/debt judgment made against me, which judgment remains unsatisfied. Yes No When complete, please send this form, along with a brief CV, to: BusinessPartners@enterprise-ireland.com Note: Any personal information which you provide to Enterprise Ireland will be obtained and processed in compliance with the Data Protection Acts 1988 & 2003. The information will be used by Enterprise Ireland in the processing of your application and for ongoing administrative purposes between you and Enterprise Ireland.