Propel Intake Form

Join Propel Today 😀

Thank you for your interest in the entrepreneurship centre at Western University. In order to best serve your needs, and to comply with our government reporting requirements, we require the following information for our files.

Once you complete this form, our business analyst will reach out to you to set up a one-on-one meeting to learn more about your idea or business.

1. Contact Information *This question is required.

First Name

Last Name

Email Address

2. Student Information *This question is required.

Are you a

Are you an international student?

3. Company/Idea Information

Enter the name of your company or idea (if you don't have a name yet, re-enter your first and last name). *This question is required.

Link to Website / Social Media Page

In 2-3 sentences, please describe your overall business or idea. *This question is required.

Please enter the number of people involved, and their current status *This question is required.

Number of full-time student founders
Number of other founders (non full-time students)
Number of paid employees (do not include founders from above)

Please provide us with the following information about your co-founders *This question is required.

Space Cell	Co-Founder 1	Co-Founder 2	Co-Founder 3	Co-Founder 4
Name	Name: Co-Founder 1	Name: Co-Founder 2	Name: Co-Founder 3	Name: Co-Founder 4
Faculty	Faculty : Co-Founder 1	Faculty : Co-Founder 2	Faculty : Co-Founder 3	Faculty : Co-Founder 4
Email	Email : Co-Founder 1	Email : Co-Founder 2	Email : Co-Founder 3	Email : Co-Founder 4

5. Other...

5. I have read and agree to the client Terms & Conditions *This question is required.