Strategy Accelerator Intake form

All information gathered in this form is used for Accelerator Facilitators and Coaches, and also for reporting purposes for Doyenne funders. we do not release any information to 3rd party entities or with other organizations

CONTACT INFORMATION-Accelerator Attendee Name (registration is for 1 female founder) *

What is your venture name? *

Principle office address? *

Mailing Address (write “Same” if same as Principle office address)

Preferred Email? *

Preferred Phone number? *

Website URL for Venture(may be social media page if no website created)

Title within Venture? *

VENTURE INFORMATION- Does your venture meet the following criteria? Mark all applicable items: *

At least 51% of employees based in Wisconsin

Have fewer than 100 employees

In operation for 10 consecutive years or less

Offer potential for increasing jobs within community and/or state which the venture is Headquartered in

Have not received aggregate private equity investment in cash of more than $10 million

Please indicate your business entity type: *

Sole Proprietorship

S Corporation

C Corporation

Limited Liability Corporation

Not registered as of time of application

What industry does your venture primarily serve? *

What year did venture start?

How much revenue did your venture generate in the last fiscal year?

Did you generate profit in your last fiscal year?

What problem and/or opportunity does your venture address?

Why should customers/clients use your venture instead of your competitors?

How many co-founders are within the venture?(Do not include applicant in answer)

1-4

5-8

If you have co-founders, what type of founder agreement do you have in place? *

Operating Agreement

Shareholder Agreement

Partnership Agreement

Do not have an agreement in place

Not applicable to my business

Is the applicant for the Strategy Accelerator the primary shareholder of the company?

Yes

No, 50/50 ownership split amongst co-founders

No, they are a minority shareholder

How many full time and part-time employees does your venture currently have?

None

1-4

5-9

10-24

25+

How many Contractors does your venture currently pay?

None

1-4

5-9

10-24

25+

Do you have interns within your venture?

Yes, they are paid

Yes, they are unpaid

No, but would like to in the future

No, this is not something I want/need within my venture

Who is your venture’s target audience?

B2B (Business to Business)

B2C (Business to Customer/Consumer)

Blended Model

APPLICANT INFORMATION - AGE?

Under 25

25-35

36-49

50+

Prefer not to answer

Gender?

Male

Female

Non-binary

Pronouns?

She/her/hers

He/him/his

They/them

Ethnicity?

American Indian

Alaska Native

Asian or Pacific Islander

Black or African American

Hispanic or Latino

White or European

Prefer not to answer

Identifies as…

LGBTQ+

Veteran

Certified Woman-Owned Business

Person With Disabilities

Time Commitment within venture

Works full-time within venture

Works part-time within venture

Does not currently work within the venture (still in idea stage or too many other life commitments)

Salary

The venture pays applicant a full-time salary or hourly rate (30+ hours/week)

The venture pays applicant a part-time salary or hourly rate (<30 hours/week)

The venture does not currently pay a salary or hourly rate

STRATEGY ACCELERATOR GOALS- What goal(s) do you hope to achieve by the end of the Strategy Accelerator Program?

What is the most pressing area of expertise you currently need access to for moving your venture forward?

Legal

Accounting/Tax & other Financials

Product Development

Strategic Direction

Life Coaching

Marketing and/or Messaging

Target Audience Acquisition

If other, please specify:

What are some areas of expertise you do not currently need to access to?