Contact Information
First Name
Last Name
Email
Phone
What is your primary or preferred language?
Please select...
English
Spanish
Arabic
Chinese
Nepali
Swahili
Other
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
Service
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...
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+
Who is your target customer?
Who are your competitors and what makes your business solution unique/better?
What progress have you made in the last 6 months?
(i.e. product development, followers gained, # of customers, revenue, general progress, etc.)
What specific goals do you have for your business over the next 12 months?
How many employees does your business support?
Founders are included in this count. Part-time employees can be counted as 0.5
How does your business intend to impact the city of Cleveland over the next 18 months?
(i.e. possible headquarters in the city of Cleveland, job creation sales revenue, social impact, environmental sustainability, etc.)
2022
2023
2024
2025
What was your annual revenue for the past 4 years?
Please enter 0 if there is no revenue
What was your annual expenses for the past 4 years?
Please enter 0 if there is no expense
What is the blended operating margin for your business for the past two years?
Blended Operating Margin = (2023 Revenue + 2024 Revenue - 2023 Expenses - 2024 Expenses) / (2023 Revenue + 2024 Revenue)
Have you ever applied for a business loan from a bank?
Yes
No
Were you approved for this loan?
Yes
No
What was the reason for the loan rejection? Select all that apply
Too much debt on current books
Not enough cashflow to support repayment
Not enough cashflow history (less than 3 years of statements)
Personal credit score not high enough
Not sure
Something else
How are you currently keeping track of your financials? Select all that apply
Quickbooks or another platform
An accountant
Excel or Google Spreadsheets
Not sure
Other
Please upload the following documents:
Note: The file size limit for each is 35MB.
Profit and Loss Statement
Balance Sheet
What is your current debt-to-income ratio?
Calculation: Debt-to-Income Ratio=(Monthly Debt Payments / Total Monthly Income)×100
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.
Which race or ethnicity best describes the
owner of your company
Please select...
African American
Asian-Indian, Asian-Pacific, Pacific Islander American
Caucasian
Latin-American/Hispanic
Native American
Other
Do you have minority business owner certification?
Yes
No
Select all that apply
Minority Business Enterprise Certified (MBE)
Women Business Enterprise Certified (WBE)
Other
Program Goals
What business goals would participating in this program enable you to achieve?
Please feel free to provide any questions/comments you might have about this 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.
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