PERSONAL INFORMATION First Name: Last Name: Ethnicity: –None–Hispanic or LatinoAmerican Indian or Alaska NativeAsianWhiteBlack or African AmericanNative Hawaiian or Other Pacific Islander Gender: –None–MaleFemale MSU PID: Citizenship: Company: CONTACT INFORMATION MSU Email (Required): Secondary Email: Phone: Street: City: State/Province: Zip: EDUCATION INFORMATION Current Academic Year: –None–FreshmanSophomoreJuniorSeniorGrad StudentOtherUnknown Expected Graduation Year: Are you Enrolled in the Entrepreneurship Minor? –None–YesNo Academic College: –None–Agriculture and Natural ResourcesArts and LettersCommunication Arts and SciencesEducationEli Broad College of Business and the Eli Broad Graduate School of ManagementEngineeringGraduate SchoolHonors CollegeHuman MedicineInternational Studies and ProgramsJames Madison CollegeLawLyman Briggs CollegeMusicNatural ScienceNursingOsteopathic MedicineResidential College in the Arts and HumanitiesSocial ScienceUndergraduate EducationVeterinary MedicineOtherUnknown Major: ONLINE PRESENCE Website: Startup Tree link. Sign up here : LinkedIn: Twitter: Facebook: Google+: EXPLAIN YOUR IDEA How did you hear about us?: –None–ReferralE-Ship CalendarClass (Specify class in the Other field)Student Org (Specify student org in Other field)Info Table (Specify info table in Other field)E-ship Newsletter EmailHatch Connect EmailEventbriteSocial Media (Specify which channel in the Other field)Other If you selected ‘Other’ please explain how you heard about the Hatch. What Industry your idea fall under? –None–AccountingAdvertising/MarketingAgricultureBiosciencesBusiness DevelopmentClothingConsultingEducationEngineeringFinanceFoodGovernmentHardwareInsuranceLegalLife SciencesLogisticsManufacturingMedicalMobile AppMusicNon-profitRetailSoftwareOther Brief Description: Describe the market problem being solved: What is Your Solution? *I certify that the information I have given on this form is complete and correct. I understand my failure to provide complete accurate and truthful information on this form and any future reporting methods will be grounds to deny or withdraw any services or funds given to me by Spartan Innovations. I agree to respond to all questionnaires and update my progress in a timely manner. I agree to treat the Hatch space and other Hatch members and interns with respect. I will not misuse the Hatch’s property, whether material or intangible and will act ethically and responsibly. I understand that the Hatch space is under video surveillance. I understand that photos, videos, and data will be used for reporting and marketing efforts.