Application

AIC Nodal Centre Form

    I.BASIC DETAILS

    Name of the Institution/ Organisation (not applicable for individuals) *:

    Name of the legal entity (as mentioned in the registration document of the entity) *:

    Year of establishment *: Registered address of the Institution *:
    District *: State *: Pin Code *:
    Website *: Name of the applicant * *: Email address * *:
    Mobile number *: Qualification *: Current Designation *:

    * Individual applying for the program or the person who will be the SPOC for AIC Raise Nodal Centre if Selected

    II.BACKGROUND

    A. Type of Applicant *:UniversityCollege
    1. Specify category *:CentralStatePrivateOther (please specify)
    2. Name of Parent University (for College):
    3. Specialisation of the educational institution (choose those applicable) *:AgricultureMedicalScienceManagementArts/ Humanities/ Social SciencesHealth, Biotechnology, Medical DevicesArts/ScienceCommerceMarketingE-commerceWater and wastewaterEngineering & TechnologyOther (please specify)

    4. Total number of students enrolled (Current academic year) *:
    Diploma: UG: PG: MPhil: PhD and above:
    5. Total number (Current academic year) *:
    Teaching faculty: Teaching faculty with PhD:
    6. Focus area for scientific research *:Agriculture & alliedAutomobileAerospaceBiotechnologyChemicalsConsumer DurablesPharmaceuticalsDefenceEducationEnvironmentElectrical & PowerEnergy (Oil, Natural gas, Petroleum)Food processingHealthcareICT & ElectronicsInfrastructureManufacturingMaterialsMedicalMiningTelecommunicationTransportWaterOther
    B. IP related
    1. Number of research papers published in past 3 years:
    2. Number of technologies commercialized in past 3 years:
    3. Number of Indian or WIPO-compliant patents filed in last 3 years:01-56-2425 or more
    4. Number of Indian or WIPO-compliant patents received in last 3 years:01-56-2425 or more
    C. Prior experience
    1. Number of entrepreneurship awareness / training programs conducted in the last three fiscal years:01-56-2425 or more
    2. Have you accelerated / funded startups in the last three fiscal years?YesNo
    3. Total number of startups supported in the last three fiscal years:01-56-2425 or more
    4. Provide brief description of start-ups and entrepreneurs supported at your institution (50 words):

    III. PROPOSED TEAM

    Proposed AIC Nodal Centre Coordinator:

    1. Has the person been identified? *YesNo

    2. If yes, Name *:

    3. Age *:
    4. Qualification *:
    5. Current Designation *:

    6. Current Organisation *:

    7. Area of Expertise *:

    8. Is the proposed manger currently holding a fulltime position?YesNo

    Student Coordinator *: Designation *: E-mail *: Mobile No *:

    IV. PARTNERSHIPS/ LINKAGES

    1. Total number of Academic and Industry Partners: 2. Total number of Entrepreneurship Partners:
    3. Provide details of 5 partners who are most relevant for the AIC:
    Name Type of partner Type of linkage Status(Existing/New) About the Partners
    Description:
    a) Type of partner: Academic, Corporate, Individual, Start-up, Government, R&D Lab, Investment, Small Medium Enterprise (SME), Others (please specify).
    b) Type of Linkages: Buyer/Vendor, Mentoring, R&D, Business Innovation, Networking, Donor, Market access, Business Support, Other.
    4. What is the main strength of the organisation that you will leverage for the AIC? *Real estate / Office spaceMaker spaceWet Lab(s)Pool of strong business / tech mentorsNetworking with other institutions / Labs / AcademiaFinance for setting up the incubatorTest beds for pilotsFaculty guidesPatent facilitation centreTechnical supportOther support services
    5. Have you taken any other grant from any Government (Centre or State) ministry/organisation on entrepreneurship and innovations? *YesNo
    If Yes, please specify details about the grant:




    6. Is the grant currently active? *YesNo

    V. REGISTRATION CERTIFICATE OF THE INSTITUTION (to be attached)

    Any other relevant document PDF(size max:1mb):
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