Contact Information
First Name
Last Name
Email
Phone
Mobile Phone Number
Company Information
Business Name
Business Address
City
State
Zip
Country
Is your home address different than your business address?
Yes
No
Home Address
Home City
Home State
Home Zip
Home Country
Website
Business Concept
Industry Categorization
Please select...
Agriculture and Environmental
Consumer Packaged Goods
Pet Products and Services
Retail, Wholesale, or E-Commerce
Food, Beverage, or Hospitality
Education
Professional Services (legal, logistics, financial, banking, accounting, insurance, communications, consulting, etc.)
Creative Services (marketing, branding, design, videography, events, entertainment, etc.)
Health, Fitness and Wellness
Beauty and Personal Care Services
Construction and Trade Services (residential and commercial construction, contracting, architecture, carpentry, electrical, utilities, plumbing, etc.)
Technology (including biotech, software, electronics)
Engineering and Manufacturing
Not for Profit
Transportation
Other
Provide a brief summary of your company/product/idea (
100 words or less
)
How long have you been in business?
Please select...
Not in business yet
Less than 1 year
1-3 years
More than 3 years
Is the business already selling its products or services?
Yes
No
How much revenue has your business generated in the last 12 months?
Please select...
No Sales Yet
$1-$25K
$25K-$50K
$50K-$75K
$75K-$100K
$100K-$250K
$250K-$500K
$500K-$1M
$1M+
How much cash
has been invested in your business to date
Please select...
$0
$1-$10K
$10K-$100K
$100K-$1M
$1M+
Demographic Information
Your feedback is important. JumpStart collects information on race, gender, and ethnicity to help advance improved economic outcomes for all entrepreneurs, including those historically disconnected from resources like capital, high-impact services, and network connections. The data demonstrates the impact to funders, community stakeholders, and civic leaders and informs our resource delivery practices. Thank you for completing this section.
Is your business
at least 51%
minority-owned?
Yes
No
Prefer not to specify
Which race or ethnicity best describes the m
ajority owner of your company
?
Please select...
African American
Asian-Indian, Asian-Pacific, Pacific Islander American
Latin-American/Hispanic
Native American
Other
Is your business
at least 51%
woman-owned?
Yes
No
Prefer not to specify
Program Goals
What business goals would participating in this program enable you to achieve?
Which of the sessions do you expect will be most valuable for you? Why?
Please feel free to provide any questions/comments you might have about this opportunity.
Program Agreement
Please note that filling out this application does not guarantee you a spot in this next upcoming cohort. Spots for this opportunity are very limited! You may also be added to a waitlist and contacted for a future cohort covering this same topic. If you are selected as a participant, JumpStart will notify you.
I understand that applying does not guarantee me a spot in this next upcoming cohort.
Please list who will be attending from your organization.
How did you hear about this specific program/opportunity?
PLEASE READ BEFORE HITTING THE SUBMIT BUTTON
In order to serve you, JumpStart personnel will need to familiarize themselves with your business and financial status. By agreeing to these terms, you agree to provide JumpStart with the business and financial information necessary to carry out its assessment. JumpStart will treat this information carefully and confidentially, and will share it publicly only when aggregated with other clients (unless you have previously made the information public). As part of JumpStart's normal collaborative work, the organization will share information with its partner organizations only if it believes it will benefit you and your business. Advice and opinions given by JumpStart to you and your company are intended solely for your benefit. JumpStart disclaims and you waive all warranties related to the assistance it provides to you. Neither JumpStart nor its directors, officers or employees shall be liable to you for damages, including, without limitation, loss of profit or business opportunity.