Request for Counseling

University of Houston APEX Accelerator

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To qualify for UH APEX Accelerator services, you must be a for-profit, legally-formed business in the state of Texas. If you have not yet formed your for-profit business, please do not continue with the application. If you have any questions contact the UH APEX Accelerator at 713-752-8477. Please answer the following questions regarding your existing business.

First Name
Last Name
Legal Business Name
DBA Name	Provide your DBA name only if you're doing business under a different name from your legal business name.
Zip Code	Enter your 5 digit Zip Code.

Position	Your title or position related to this business
Address	Your physical street address (number and street) of the business. Do Not use a P.O. Box. If a home based business, use your home address.
Address Line 2	Optional. Use for additional address postal information like apt, floor, suite, etc.
City
State

Please enter contact information regarding this business so that we may contact you if necessary

Primary Phone	The best phone number (with area code) to reach you during our standard business hours. Include extension if necessary.
Primary Phone Type	Type of the primary phone above
Secondary Phone	A secondary phone number to contact you, if we cannot reach you at the primary number.
Secondary Phone Type	Type of the secondary phone above

Web Site	Web site URL for the business

Please answer the following demographic questions about yourself.

Race	Asian Black or African American Native American/Alaska Native Native Hawaiian/Pacific Islander White Prefer not to say Check any that apply
Hispanic Ethnicity
Gender
Person with Disability	Do you consider yourself a person with a disability
Military Status

Business Status

Existing For-Profit Business

This box must be checked to qualify for UH APEX Accelerator services. If you have not yet formed your for-profit business, please do not continue with this application.

Please enter the following information for your business concern.

Are you the majority owner of this business?	Yes If you are not the majority owner, please stop and do not proceed with the application. The application must be submitted by the majority owner. If you have any questions contact us at 713-752-8477.
Ownership Percent	% Enter the ownership percent for this business.
Year Started	Year this business started
Month Started	Month this business started
Business Type	Primary category of business
Female Ownership %	% Enter the percent female ownership for this business.
Business Online	Yes If business is conducted online
Home Based Business	Yes If business is home based

Business Organization	Legal entity of the business
Current Number of Full Time Employees	Count yourself if you are working full time with the company
Current Number of Part Time Employees	Count yourself if you are working part time with the company
Annual Sales $	Annual Sales $ for the most recent full business year

Current Certifications

Federal SDB Self-Certified

Federal 8(a)

Federal EDWOSB

Federal HUBZone

Federal SBA VetCert Program

Federal WOSB Self-Certified

Federal WOSB WBEA

Local CoH MBE

Local CoH PDBE

Local CoH SBE

Local CoH WBE

Local GH LGBTQ BE

Local HMSDC MBE

Local Metro DOBE

Local Metro SBE

Local Metro VOBE

Local POHA SBE

Local WBEA WBE

SoT HUB MBE

SoT HUB SDVOSB

SoT HUB WBE

SoT TUCP DBE

SoT TXDOT SBE

Only check active certifications. Do not check if you are applying, have pending applications in process, or expired certifications.

Needs/Requirements: Clearly and succinctly let us know how the UH APEX may help. Please be as specific as possible, including prioritizing by numbering if you have more than one/1 need/requirement.
Describe specifically what you want to sell to government.
UEI Code	If you have a UEI code, enter it here. UEI Codes have replaced DUNS Numbers. The unique entity identifier is a 12-character alphanumeric ID assigned to an entity by SAM.gov.
If you have a Commercial and Government Entity (CAGE) code, please enter it here.
How did you hear about us?	Choose the best category above.
Details for how you heard about us	Briefly describe the person or resource name of how you heard about our services.
What is your Geographic Service Area where you can provide your services?	Choose the best category above.
Other States if applicable

Our main office is located at 1455 W. Loop South, Suite 890, Houston, TX 77027. We offer services at this location Monday - Friday.

Select the Office Location to Meet with Your Advisor

Choose the preferred location.

The majority owner can designate an employee (Designated Representative) to meet with a UH APEX Accelerator advisor without the majority owner present. The Designated Representative must be a W2 employee of the business and cannot be 1099 Independent Contractors. If you (majority owner) plan to assign a Designated Representative, provide the information required in the appropriate areas of this page, else proceed to the next page. Do not enter the majority owner’s information in the Designated Representative fields below.

Designated Representative Last Name and Title
Designated Representative Work Phone
Designated Representative Cell Phone
Designated Representative Email Address

Please read each of the following three (3) service agreements. They will open into a new tab for your review and they can be saved for future reference. In order to receive our services, you must agree to accept each of these three service agreements.

Client Engagement Agreement (EA)
Client Rights and Responsibilities (CRR)
Client Survey Information (CS)

UH APEX Accelerator Client Service Agreements

I have read the UH APEX Accelerator Engagement Agreement, Client Rights and Responsibilities, and Client Survey Information documents in this application and agree to their terms and conditions.

Please read the following, enter your Full Name, and click Continue below to indicate your acceptance.

I request no-cost business advisory services from the UH Bauer APEX Accelerator, a program of the U.S. Department of Defense and the UH Bauer College of Business.

I agree to participate when I am asked to complete surveys designed to evaluate those advisory services.

I self-certify that neither I nor my company are currently suspended or debarred by a Federal agency.

I certify that my business has not been, is not currently, nor will it at any time be operated or otherwise used in any manner that is in violation of criminal law, nor has it assisted, nor is it currently assisting, nor will it at any time assist another individual or entity in any manner that violates criminal law. I agree to release, indemnify, and hold harmless, the University of Houston System, the University of Houston, the APEX Accelerator and its host organizations, as well as each of the above entity’s respective board members, officers, directors, employees, authorized representatives, advisors, and other personnel (”Releasees”) from and against any and all liability that may arise from the actions (negligent or otherwise) by me, my business, or its employees, as well as against any and all claims or causes of action that may be brought against the Releasees by me, my business, my employees, or any third party, or that may be brought against me, my business, or its employees, by a third party.

Please enter your full name, indicating your acceptance of the above terms.

Full Name:

Date: 4/27/2024 4:09:04 PM

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