Please note: This program application is now closed. Please DO NOT fill out this form. If you are interested in joining an AC program, please use this link to access our other available programs.

Thank you for your interest in AC:Incubate+. Please apply to this inaugural program by completing all sections of the form below. Due to funding requirements, space is limited. Only applicants invited to participate in the program will be contacted.

First name*

Last name*

Email*

Phone number*

Company Operating Name*

Business / Personal Street address*

City*

State/Province*

Postal code*

Country/Region*

Company domain name*

Are you the majority shareholder in the company?*

Yes

Founder Occupation (Please select all that apply)*

Entrepreneurship Experience*

Company Legal Status*

Business Industry*

Please Note: Due to funding requirements, AC:Incubate+ is for Founders of STEM-based (Science, Technology, Engineering, Mathematics) businesses only.

Business Description*

Tell us about your business and product and/or service

Are you, or any member of the founding team: (Please select all that apply)*

If you selected "Other," please specify the areas of your business where you need the most support.

Are you able to commit to attending at least 80% of the weekly, in-person elements for the duration of the 6 months?*

AC:Incubate+ is a hybrid program with weekly, in-person components to be held at AC Headquarters in Waterloo (295 Hagey Blvd, Waterloo, ON N2L 6R5) on Wednesdays from 9:30am-11:30am.

Yes

Total Canadian Revenue (CAD$) for the Past 12 Months*

Total Non-Canadian Revenue (CAD$) for the Past 12 Months*

If "Other", please specify the type of funding you have received:

Total Funding Raised to Date_Canadian Sources (CAD$)*

Total Funding Raised to Date_Oudside Canadian Sources (CAD$)

What encouraged you to apply to the Accelerator Centre's AC:Incubate+ program?*

Other things I'd like to accomplish in the program

How did you hear about the AC:Incubate+ program?*

If you selected "referral," please specify the referee's name and relationship. If you selected "Other," please specify how you heard about us.

All employees of the Accelerator Centre are bound by an internal NDA. By clicking "Submit" below, you are giving permission to the Accelerator Centre to confidentially store and review this information for the purposes of intake into the program. You are also representing that all the information provided is true and accurate to the best of your knowledge. By checking the box below you are agreeing to the above statement.*

I Agree