"
*
" indicates required fields
PERSONAL INFORMATION
Name
*
First Name *
Last Name *
Gender Pronouns
*
Email
*
Phone
*
Personal Address
*
Street Address *
City *
State *
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip Code *
Gender
*
Race / Ethnicity
*
Number of People in Household
*
Household Income
*
Please select one of the following:
Less than $35,000
$35,000-$50,000
$50,000-$100,000
Greater than $100,000
How did you hear about this opportunity? (check all that apply)
*
Uptima Newsletter
Uptima Website
Uptima Alumn
RUNWAY
REAL People's Fund
Word of Mouth
Facebook
Instagram
Twitter
LinkedIn
Google Search
Have you completed a business training program for this business in the last four years?
Yes
No
If so, which business training program(s) have you completed for this business in the last four years?
PROGRAM OF INTEREST
Where I’m located:
*
Oakland / East Bay Metro Area
Boston Metro Area
Chicago Metro Area
I am looking to grow a business as a:
*
Hobbiest: Something I'd like to do in my spare time
Side hustle: Keeping my full-time job and doing this business as an indefinite side hustle, a way to make a little extra cash
Freelancer / solopreneur: Work in my business full time and don't intend to hire a team
Scalable business: Work in my business full time and plan to hire a team
I’m at the following business stage:
*
Exploring entrepreneurship: I like the idea of being an entrepreneur, but don't know what business I want to start
Idea phase: I have a great idea for a business that I haven't tested yet
Go-to-market stage: I have tested my business idea and am ready to start making sales
Early stage: My business is launched and generating some sales, though not consistently
Scaling: My business is established, generating consistent monthly sales, and is ready for the next level
Mature: My business is well established and has slow and steady growth
Retention: My business well established and is at risk of displacement or closure
BUSINESS INFORMATION
Business Name
*
Business Address
Business Street Address *
Business City *
Business State *
Business Zip Code *
Business County *
How long have you been in business?
*
What is your current annual business income:
*
Pre-revenue
Less than $500
$500-$5,000
$5,000-$10,000
$10,000-$25,000
$25,000-$50,000
$50,000-$100,000
$100,000-$250,000
More than $250,000
Was the business profitable last year?
*
Yes
No
I'm not sure
How many other people are working in the business besides yourself? If you are the only person working in the business, please enter zero.
*
What is your business legal entity type?:
*
Sole proprietor / I don't have a business entity set up yet
Single member limited liability company
Limited liability company
S Corporation
C Corporation
Benefit corporation
Non-profit
I'm not sure
Is your business a cooperative?
*
Yes
No
In the process of becoming one
I'm not sure
Business Description (min 50 words)
*
Website
Instagram
Facebook
LinkedIn
What experiences motivated you to start this business? (min 75 words)
*
What positive social, environmental, and economic impact do you want to create with your business? (min 75 words)
*
What are you most proud of in this business so far? (min 75 words)
*
What has been a major challenge that you have overcome in this business? What did you do to overcome this challenge? (min 75 words)
*
What are your goals in this business right now? (min 75 words)
*
What are your major challenges in this business right now? (min 75 words)
*
How has COVID-19 affected your business? What have you been doing to stabilize and pivot your business in this new environment?
*
How much money have you raised for the business so far?
*
How have you financed the business so far? (check all that apply)
*
Personal Income / Savings
Credit Cards
Grants
Friends & Family
Small Business Loan
Crowdfunding
Equity Investment
I haven't financed this business yet
How much capital do you currently need to grow your business? If you do not currently need to raise capital to grow your business, please enter zero.
*
How will you use the capital to support your business? If you do not currently need to raise capital to grow your business, please enter "Not applicable."
*
When are you looking to secure capital? If you do not currently need to raise capital to grow your business, select "Not applicable."
*
3 months from now
6 months from now
1 year from now
Not applicable
Do you have a business plan and a financial forecast for this business? If you do not currently have a business plan or financial forecast, please enter "Not applicable."
*
Yes
No
Not Applicable
When was it last updated? If you have not updated your business plan and financial forecast please enter "Not applicable"
*
PROGRAM EXPECTATIONS
How do you see our programs benefitting your business? (min 75 words)
*
How do you see yourself contributing to our community? (min 75 words)
*
OPT-IN
Would you like to receive emails and other information from our funding partners? (check all that apply)
RUNWAY: Provides Black entrepreneurs with affordable, patient, "friends and family" style funding, weekly coaching and a thriving community of support (Oakland / East Bay, Boston, Chicago)
The REAL People's Fund: A community capital fund offering equitable access to finance for small businesses in the historically disinvested communities (Oakland / East Bay only)
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