Commercialization Center for Innovative Technologies

Executive in Residence Application

Mentoring Emerging Life Sciences Companies

located in the Commercialization Center for Innovative Technologies

CCIT’s Executives in Residence Program

Applications:Accepted at Any Time
New EIR Selections:Made on a quarterly basis, by CCIT’s Advisory Board in partnership
with BioNJ
Next EIR Start Date:April 1st, 2015
Location: Commercialization Center for Innovative Technologies
675 US Highway One
North Brunswick, NJ 08902


Please provide the information requested below to be considered for an Executive in Residence
appointment at CCIT. Within 5 days of submitting the required information, you will be contacted
to confirm receipt.

First Name:
Last Name:
Daytime Phone Number:  
Full-Time Address:
Street Address 1:
Street Address 2:
State: New Jersey
ZIP Code:
How did you hear about this program?
Please indicate your area of expertise:

Please answer these three questions:
1. Please tell us what you hope to get out of the EIR program (Maximum 1,000 words)

2. Please tell us what sets you apart from the other highly qualified applicants to the EIR program (Maximum 1,000 words)

3. Please outline any experience you have with entrepreneurial ventures (in small or large companies) (Maximum 1,000 words)

Please attach, preferably in PDF format, your current resume and a list of 3 current references, with their contact information and their relationship to you.

All applicants for the CCIT Executive In Residence Program must complete and sign the Agreement for Consulting Services, and upload that completed form along with the resume and reference list in order for the application to be considered complete.

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