Apply to Participate in our next Course or Workshop! Date MM DD YYYY Which course or workshop do you wish to participate in? Pre-Incubator Course Incubator Course Workshop Your Company Name * First Name Last Name Email * Phone (###) ### #### Address What is your LinkedIn URL? http:// What is your website URL? http:// What is your Company's Corporate Structure? Sole Proprietorship Partnership Limited Partnership Limited Liability Corporation S Corp C Corp 501c3 (nonprofit) B Corp Other What is the mission of your organization? (what your org does, for who, where, and how?) What is the problem you are solving for your customers? How would you describe your ideal customer? What principles guide how you work with your customers? How many customers do you have and what is your average revenue per customer? What substitutes (similar to your product or service) do people currently resort to? What makes your offering (product or service) unique? Please select the most appropriate stage of your company's development: Developed a great idea to solve a problem Defined my product/service and building a prototype Formed a legal entity and recruiting/ed co-founders Started alpha testing of a prototype and users confirmed that solution works/solves problem Based on user feedback a fully functional product/service was built ready for beta testing with paying customers Product/service was introduced to market and users paid for it Product/service was accepted by a wider but particular user group(s) (fans) Product/service was adopted by multiple customer segments Other Are you bootstrapping the development of your company? Yes No Are you raising capital to finance the development of your company? Yes No Have you raised capital in the past? Yes No How long can you run your company based on your currently available capital? 12 months 9 months 6 months 3 months I am already out of money I am bootstrapping Other What development do you require as a founder? Business strategy Business operations Business process development Brand development and PR Traditional and/or digital marketing Business development/sales Partnership development Customer service and success Social Media Marketing and Content development Product/service development Customer pipeline development and CRM Talent strategy/recruitment and HR management Leadership development and strategy Investor prospecting and fundraising Goal setting and measurement Team and culture building Data analytics and management Business modeling Prototype Development Financial planning and forecasting Other Does your company have...? Board of Directors Board of Advisors CPA and/or Accountant Mentors and/or Coaches Investors Legal Advisor Other Do you work in your business full-time? Yes No Do you have a co-founder? Yes No Do you have employees (part or full time)? Yes No If you have employees, how many and in what functions? How did you hear about us? Social Media Internet Search Friends or Colleagues Community Event News Article Other Any other information you may want to share about you and your company? Thank you!
