Connecticut Innovations, Inc.
Fiscal Year Ending June 30, 2024

Employment Information Request Form

Section I
Name of Company*
Federal EIN Number
Contact Name*
Contact Title
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Website
Phone
Email
CT Tax Reg. #
Section II
(full time = over 35 hours/week; part time = less than 35 hours/week)
Total employment as of 6/30/2024 (Full Time)

Total full time employees including full time paid interns as of 6/30/2024
Total employment 6/30/2024 (Part Time)

Total part time employees including part time paid interns as of 6/30/2024
Total employment in Connecticut as of 6/30/2024 (Full Time)
Total employment in Connecticut as of 6/30/2024 (Part Time)
Total employment in Connecticut as of 6/30/2024 (Consultants)
Average Annual Wage Per Employee (Full Time)
All full time employees including full time interns.
Average Annual Wage Per Employee (Part Time)
All part time employees including part time interns.
Average Annual Wage Per Employee (Consultants)
Average Annual Wage for new hires in Connecticut as of 6/30/2024 (Full Time)
Average Annual Wage for new hires in Connecticut as of 6/30/2024 (Part Time)
Average Annual Wage for new hires in Connecticut as of 6/30/2024 (Consultants)
Section III
NAICS Code

Please ensure you are proving the most up-to-date code as they have recently been updated
Gross revenue ($) for latest year ended
Date fiscal year ended
MM slash DD slash YYYY
Minority-owned
- Yes
- No
Veteran-owned
- Yes
- No
Women-owned
- Yes
- No
Disabled-owned
- Yes
- No
Section IV
# Patents pending
# Patents approved
Hidden
Current Capitalization Table
Drop files here or

Max. file size: 50 MB, Max. files: 2.
Hidden
Audited (if available) or unaudited financial statements for FY ending in 2023
Drop files here or

Max. file size: 50 MB, Max. files: 6.
Hidden
Latest YTD Financial Statements for 2024
Drop files here or

Max. file size: 50 MB, Max. files: 6.
Name of preparer*
Name Title
Date*
MM slash DD slash YYYY
Contact Elizabeth Skrabl with questions. elizabeth.skrabl@ctinnovations.com 860.258.7875.
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Connecticut Innovations, Inc. Fiscal Year Ending June 30, 2024

Employment Information Request Form

Section I

Section II

Section III

Section IV

Connecticut Innovations, Inc.
Fiscal Year Ending June 30, 2024