Application for Legal Support

Application Form
Founder Name*

First NameLast Name
Founder Email*
example@example.com
Company Name*
Company Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Website URL
UC Campus Affiliation, if Any*
Non-confidential description of your company, your market, and the product or service you are developing. (Be specific. For instance, "a platform technology to uncover new therapeutics" is too general.)*
What industry best describes your technology? (Choose one)*
If your technology is specific to a particular human disease, please indicate the label that best applies.*
If you have one, please enter a non-confidential executive summary.
Or attach a pitch deck.

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What do you need? (Choose all that apply; Shift or Ctrl-click to select multiple options)*
How did you hear about QB3?*
You will be redirected to a confirmation page upon submission. You should also receive a confirmation email with this link at the address you entered above. A QB3 team member will be in touch shortly.
Should be Empty:

Application Form