​​​​​Are you an Alberta entrepreneur with a technology/knowledge-based novel innovation?

​‌Alberta Innovates support high potential, high growth technology/knowledge-based companies to bring novel innovations to market.  Small to medium sized enterprises with a minimum viable product benefit from our coaching and community connections to advance and scale their project/product. 

Are you interested in speaking with Alberta Innovates about our programs? Please complete the following questionnaire and we will respond within 48 hours.

PLEASE NOTE THIS IS NOT AN APPLICATION FOR FUNDING/GRANT SUPPORT
MANDATORY FIELDS *

Company

Legal Company Name **
Trade Name *
Year of Incorporation 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900
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No. of Employees **
Website *

Primary Contact

First Name **
Last Name **
Phone **
Email ***
Job Title **

Address

Street 1 **
Street 2 *
City **
State/Province **
ZIP/Postal Code **
Country **

Secondary Contact

First Name *
Last Name *
Phone *
Email **
Job Title *

Requirements & Business Overview

Please describe your specific requirements in the text box below **
Describe Your Business. Who are you and what does your company do? **
Describe your innovation or product **
Describe your target customer and market **

Equality, Diversity and Inclusion

Please indicate your current age in years 18-24 25-34 35-44 45-54 55-64 65+ Prefer not to Answer	Please select the option that best describes you Man Woman Gender fluid, non-binary and/or two-spirit Prefer not to Answer
Do you identify as Indigenous; that is First Nation (North American Indian), Métis or Inuk (Inuit)? Yes No Prefer not to Answer	Do you identify as a member of a visible minority? Yes No Prefer not to Answer
Are you a person with a disability? Note: Person with a disability is a person who has a long‐term or recurring physical, mental, sensory, psychiatric or learning impairment and Who considers themselves to be disadvantaged by reason of that impairment; or Who believes that an employer or potential employer is likely to consider them to be disadvantaged in employment by reason of that impairment; and Includes persons whose functional limitations owing to their impairment may have been accommodated in their current job or workplace Yes No Prefer not to Answer

Communication

How did you hear about Alberta Innovates * Advertisement Employee Referral External Referral Partner Public Relations Seminar Trade Show Web Word of Mouth Twitter Other	Who referred you (i.e. organization name, contact) *
Please send me communications about our programs, related announcements, new funding opportunities, or updates to same. You may unsubscribe any time by contacting intake@albertainnovates.ca. * Please send me communications about our programs, related announcements, new funding opportunities, or updates to same. You may unsubscribe any time by contacting intake@albertainnovates.ca. SendPlease send me communications about our programs, related announcements, new funding opportunities, or updates to same. You may unsubscribe any time by contacting intake@albertainnovates.ca. Do Not Send

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All information is collected in accordance with Alberta’s Freedom of Information and Protection of Privacy (FOIP) Act