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Membership Application

Magnify at CNSI - Incubator Application

This form is to be filled out by prospective companies that would like space in the Magnify Incubator. All applications will be reviewed by the Magnify Management Team and evaluated for suitabilty.
  • Primary Contact Information:

  • Title/Position
  • Phone
  • Email
  • Address:

  • Company Information:

  • Company Name
  • Type of Business Entity
  • Company Website
  • Briefly describe your company and the technology you are developing:
  • List any successful milestones achieved to date:
  • Technology & Market:

  • What problem does your company/product address?
  • Define and quantify the target market(s) for your solution:
  • Describe how your technology uniquely addresses this problem. Define the competitive advantage/value proposition(s) your product offers to customers:
  • Stage of Development (initial prototype, advanced prototype, preclinical, clinical, manufacturing, marketing):
  • Provide a list of the key technology development milestones to be worked on at the Incubator and an anticipated timeline to achieve each of those milestones:
  • UCLA Affiliation:

  • Please summarize your company’s proprietary intellectual property (IP) and the current status of any option/license agreement(s) with UCLA for the underlying IP rights. Include inventor(s) name(s) and UCLA case number, if known.
  • Describe any planned or ongoing collaboration your company has with UCLA professors and labs/centers:
  • Funding:

  • Summarize the current funding status of your company (e.g. angel, venture capital, government, corporate, philanthropic, and other) including a total amount of current working capital:
  • Describe how capital will be used to achieve your business goals during the first 6-12 months in the incubator:
  • Team:

  • List all founders, executive team, and board/advisory members and briefly summarize their relevant expertise:
  • What is the current number of Full-Time employees with your company?
  • What is the current number of Part-Time employees with your company?
  • How many employees do you expect to be working in the incubator?
  • Facility Requirements:

  • What type of space do you need? (select all that apply)
  • Please elaborate on the type and amount of space needed:
  • List any instrumentation and hardware you are planning to bring into your space at the incubator:
  • What is your desired start date to enter the Incubator and anticipated timeline to exit the incubator?
  • Describe any additional facilities/workspace your company will be using outside of the incubator:
  • Indicate if you plan to conduct research in the incubator involving any of the following:
  • Please select which, if any, CNSI’s Technology Centers your company intends to use if admitted into the incubator:
  • Additional Information:

  • Describe the benefits of the Magnify incubator in relation to your specific company at its current stage:
  • How did you hear about Magnify? (Friend, Current Member, News Article, Social Media, Search Engine, Networking Event, Other)
  • Please upload your pitch deck and/or executive summary
    Drop files here or
    Accepted file types: jpg, gif, png, pdf, doc, docx, ppt, pptx, txt, rtf, .
  • This field is for validation purposes and should be left unchanged.