Expression of Interest

* Are you currently a Lambton College employee or a student?

Company Profile

* Company Name:

* Company Address:

Address Line 2:

* City:

* Postal Code:

* Country:

Company Website:

* Telephone:

Extension:

* Contact Name:

Title:

* Email:

* Is your company registered in Canada?

* Number of Employees

Full time:

Part time:

* Brief Description of the Company:

(such as current financial support, key members of management team, products on market, expected time to market entry etc)

* Do you have Research & Development?

Project Description

* Project Title:

* Project Description:

(including the perceived business opportunity, potential economic development impacts such as jobs created, increased revenues, new markets entered etc)

Desired Project Outcomes:

(eg. Prototype built, process developed, market research conducted etc.)

* Assistance Required From the College / Areas of Expertise Required / Equipment and Facilities / IT Equipment and Services:

(eg. Photonics, Mechanical Engineering, etc.)

Desired Start Date:

Desired End Date:

Estimated Amount of Contribution ($CAD)

Cash:

In-kind:

Attachments:

Please attach any supporting documentation. Documents may be in Word, Excel, PDF, or an image (JPG, GIF, PNG) format.

Appendix A: Project Plan

Milestone

Duration

Description

Appendix B: Estimated Budget

Estimated Equipment & Consumable Required

Price Estimate:

Equipment List:

Additional Comments and/or Requests

Additional Comments and/or Requests:

Research & Innovation

Applied Research

Company Profile

Project Description

Appendix A: Project Plan

Appendix B: Estimated Budget

Additional Comments and/or Requests