EIR Request Form - Connecticut Innovations Connecticut Innovations

Venture Team Member(Required)

Approved by(Required)

Portfolio Company Name(Required)

What Fund?(Required)

EIR Specialty(Required)

Choose one or more that apply

"Other" EIR Request

EIR Proposed Duration(Required)

# of weeks/# of months

EIR Proposed Budget(Required)

greater than >$25,000 (converts to debt/equity)

Will the proposed budget cover debt/equity?

If yes, What Investment Vehicle?

EIR person identified?(Required)

Yes

Name of identified EIR candidate or firm

CAPTCHA

Phone

Address

470 James Street, Ste 8
New Haven, CT 06513