Iowa APEX Request for Counseling

Please enter the following information

The questions marked with an asterisk are required fields. If you have questions on any of the other fields, leave the field blank and your CIRAS APEX specialist will assist you after submitting the form.

I request counseling assistance from Iowa State University CIRAS-APEX Accelerator. I understand and agree to participate in and return requested quarterly surveys within 7 days of request as they are designed to evaluate the APEX Accelerator services. As a client, I realize that I will occasionally receive notices, announcements, and marketing materials designed to inform and assist me.

I further understand the following:

I understand that if the expectations of this Service Commitment are not met, CIRAS APEX reserves the right to change my status from Active to Inactive. By submitting this form, I certify the above information is correct.

By my signature below, and in consideration of CIRAS-APEX Accelerator furnishing of procurement, management, or technical assistance, I waive all claims against Iowa State University, CIRAS-APEX Accelerator personnel and its host organization(s).

I understand that there are no warranties or assurance in connection with the counseling assistance. This agreement must be executed by an authorized official of the Client company or organization.