* 1. Student Name:

* 2. Student Phone:

* 3. Student Email:

* 4. What is your major?

* 5. What year are you?

* 6. Briefly tell us about your startup that you wish to speak with the EIR about:

* 7. Has your startup already launched?

* 8. Give us a sample of 5-10 questions you would ask the EIR should you be selected:

9. Are you a member of the Chapman EClub (Entrepreneur Club)?

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