Contact Information




Company Information



What year was the company legally formed? If not yet incorporated, enter the year the founding team began working on it.

















This question is for state reporting purposes. Please select the option that best fits your company. If none feel like a perfect fit, select the closest match - JumpStart staff can review and refine internally if needed.
What You Are Building and Why

Describe your product or service and how it works in one to two sentences. Plain language is better than jargon.


Be specific - number of conversations, clinical pilots, LOIs, IRB approvals, pilots, KOL endorsements paying customers, waitlist, or anything else concrete.






Record a one-minute video introducing the founder(s). Founders on camera, no slides, no demo. Upload to YouTube (unlisted) or Loom and paste the link here. We want to see and hear you, not your deck.
Traction and Funding




Enter 0 if no paying customers yet.

Enter a whole-dollar amount with no symbols or commas. Example: enter 50000, not $50,000 or 50,000.00 or 50K.

Include grants, equity investment, and convertible notes. Enter a whole-dollar amount with no symbols or commas. Example: enter 250000, not $250,000 or 250K.


What are the 2-3 most important things you need to accomplish in the next 6-12 months for this company to be on track and how much are you looking to raise?



If so, which one and when?
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.



Team Member Information










Enter a number between 0 and 100. Do not include the % symbol









Enter a number between 0 and 100. Do not include the % symbol









Enter a number between 0 and 100. Do not include the % symbol


Tell us about your unfair advantage - domain expertise, customer relationships, lived experience, technical depth, or prior failures you've learned from.
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.