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Project LEAD Form
College of Engineering and Computer Science

Contact Information
Name:

Position or Title (Owner, Manager, etc.)

Company (if applicable):

Address:

Suite / Apt.:

City:

State:

Zip:
Business Phone:
 
Facsimile (Fax)
 
Home/Cell Phone:
 
Email:

Website & Business Description:


Business Information
Are you currently In-Business?:
Yes - Start Date
No

If "Yes", please choose business type
(Please Choose One)
 
Retail Manufacturing
Service Construction
Wholesale Other(s)
Business Organization (Please Choose One)
 
Sole Proprietor Undecided
Partnership S-Corp
Corporation LLC
No. of Employees:      Est. Annual Sales $   SIC Code:

NAICS Code:(if known)    

Area(s) of Interest
Mentoring   Donation(s)   Internship(s)/Scholarship(s)   Other(s)

Project Information
When is the est. Project start date?

When is the est. Project deadline?  

If secondary FAU resources are required, please list (e.g. College of Business)


Will your organization provide Project and/or research funding?

Yes - $ 
No

Is faculty required to supervise or provide research?

Yes No

Are students required?

Yes - how many? 
No

If "Yes", then:

Graduate Student
Undergraduate Student


Please describe project details, communicate outcome expectations: