Memberships start at $200 a month, contact us to find the membership that best fits your team!

Thank you for your interest in the Innovation Center @3401! Before you get started, let’s get some housekeeping items out of the way. Please note that this form is an initial application. You may be invited to complete a more detailed evaluation form further down the road. Please note that there are character limits for all fields. Finally, please return this form to Kristin Hart at If you have questions, Kristin is your go-to person.

We want to learn more about you, but we don't need to know everything! Please do not include confidential information in this form. If we need further information from you in order to make a determination about your eligibility to be a resident of ic@3401, we will contact you, and we may enter into a non-disclosure agreement at that stage.

Disclaimer: The information provided in these checkboxes is not used for making determinations of eligibility or award and is collected for tracking purposes only.

Today's Date *
Today's Date
Name *
Phone *
Company Status *
Date of Formation
Date of Formation
Month and Year requested, day if known.
Business Classification: Information provided in these checkboxes is not used for making determination and is collected for tracking purposes only.
I am a(n)
Industry Sector(s) *
Platform *
Membership need *
Full time vs. Part Time
Which programming/learning opportunities are you most interested in?
Existing Academic Collaborations
Please tell us about the maturity of your business model.
Please tell us a little about your current funding or capital sources