CIS - Technology Services Survey

The University of Tennessee uses its staff and resources to help companies and their technology-based products in one of three ways listed below. Before you access those services, please complete this Services Survey. From the survey results we will direct you to the staff and resources to help you:

In cases where there is not a staff or resource match for your needs identified on the survey, we will identify a resource outside the university that may help you.

UT-CIS Technology Services Survey

Required fields are in Bold

Company Name:		Point of Contact:
Work Number:		Title/ Position
Cell Number:		E-mail Address
Fax Number:		Web Address
Business Owner	Yes No

Mailing Address
Address:
City:		State:
Postal code:

Location Address (if different from mailing address)
Address
City		State:
Postal Code


Do you want to use a UT Professor and UT Research Infrastructure? Yes No
Do you have resources to pay for professors that would help write proposals? Yes No
Do you have resources to pay for research infrastructure that would help you build your prototypes and products? Yes No
Do you have a registered company (i.e., Do you have a DUNs number)? Yes No
Has your product received SBIR Phase 1 AND Phase 2 awards? Yes No
Do you have a product concept you want to manufacture, evaluate, buy, sell or license? Yes No
Do you want your staff to learn how to successfully create and evaluate new concepts for business growth? Yes No

Business Type:

Manufacturer
Service
R&D
Not yet in Business

Organization Type:

Individual

Partnership

Corporation

Sub S Corporation

Limited Liability Co.

Business Size:

Disadvantaged small
8(a)
SDVO small business
Woman-owned small
Other small
Large

Business Range:

Entire US
Southeastern US
Tennessee Only
International

Annual Sales ($)(3 Year Average):

0 - 100,000

100,001 - 250,000

250,001 - 500,000

500,001 - 1,000,000

1,000,001 - 5,000,000

Over 5,000,000

Employees

0 - 10

11 - 50

51 - 100

101 - 250

251 - 500

Over 500

State of Incorporation:

Date Established:

Ethnic Group:

American Indian
African American
Caucasian
Asian/Pacific
Hispanic

Military Status:

Veteran
Vietnam-era veteran
Disabled veteran
Non-veteran

HUB Zone:

Yes

Certified

Are you in a HUB Zone?

Referred By:

Do you have and existing relationship with ORNL or UT?
Yes No

Has this company been debarred from performing federal contracts?
Yes No

I request business management assistance from the University of Tennessee Center for Industrial Services. I agree to cooperate should I be selected to participate in surveys designed to evaluate these services. I authorize the Center to furnish relevant information to the assigned counselor (s), with the expectation that information is to be held in strict confidence. I further understand that all counselors have agreed not to (1) recommend goods or services from sources in which they have an interest not to (2) accept fees or commissions developing from this procurement-relevant counseling relationship.

By checking this box, I have read the above and waive all claims against the Center's personnel and its host organizations. I understand that there are no warranties or assurances in connection with any assistance offered by the Center.

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Technology Services Survey

UT-CIS Technology Services Survey