SHARPhub Program Application
Please enter your first and last name
What is your preferred email address?
What is your preferred phone number?
If affiliated with an academic research institution, select from the following list:
University of Kansas Medical Center
University of Nebraska Medical Center
University of North Dakota
University of Oklahoma
University of South Dakota
If "other," please provide the name of the academic institution with which you are affiliated and the state in which it is located:
What is your role at the university?
Postdoc / Fellow
What is your company's name? (If not formed put "none")
What is your role within the company?
Please enter your preferred mailing address.
What is your company website address? If you do not have a website please leave blank.
Is your Company?
Native-American/Alaskan Native/Pacific Islander Owned
None of the above
Prefer not to answer
What is the legal structure of your business?
Limited Liability Company (LLC)
Not formed yet
In what year and month was the company formed? If you have not formed a company yet, leave blank.
If "other", please explain:
If your company has a business mentor, please provide the name and affiliation, if applicable.
How did you hear about the SHARPhub Program?
Page 1 of 4