StartUP Columbus Incubator Program Application Name * First Name Last Name Email * Phone * (###) ### #### Postal Code * Please Select Your Age * Under 18 18-24 25-34 35-44 45-54 55-64 65+ Please select your gender * Female Male Transgender Gender Non-conforming/Non-binary None of the above Please select your race/ethnicity * White Black or African American Hispanic or Latino Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Another race/ethnicity Do you identify as any of the following communities of interests? * Founder of a social enterprise (maximizing both social images and profit) LGBTQIA+ Military service New American citizen or immigrant Person of Color None of the above Are you a current or former member of the U.S. Military or National Guard? * Yes No Do you have a physical or mental impairment which substantially limits you in one or more major life activity; or have a record of having such an impairment; or are regarded as having such an impairment? * Yes No Prefer not to answer What is your annual income? * Under $15,000 Between $15,000 and $29,999 Between $30,000 and $49,999 Between $50,000 and $74,999 Between $75,000 and $99,999 Between $100,000 and $150,000 Over $150,000 What is your Social Security Number? * Business Name * In 40 words or less, please describe your business: * Type of Business: * Business: a venture that exists to provide a product, software, or service that people are willing to buy Cause: a venture that exists to provide sustainable impactful solutions to social, cultural, and environmental problems Is your business registered? * Yes No If so, what state is your business registered in? * What is your primary need for the Incubator Space at StartUP Columbus? (e.g. office space, conferencing area, etc.) * How many members of your team will use StartUP Columbus Incubator regularly (at least one day per week)? * Just myself 2-3 More than 3 Do you plan to use the StartUP Columbus Incubator address for your certificate of Occupancy? * Yes No Have you visited or toured StartUP Columbus? * Yes No Have you completed the CO.STARTERS program? (Not a requirement) * Yes No Please print your name below as a digital signature to complete this application. * Thank you! Thank you for your interest in the incubator program at StartUP Columbus!We have outlined what to expect belowThe Application Process is as follows:Applicant submits incubator application to StartUP ColumbusStartUP Columbus reviews applicationA meeting is set to build rapport, discuss findings, and ask any questionsA background check is conducted for the applicantApplication is submitted for approval to the Director of StartUP ColumbusAfter approval is communicated and accepted, new client and director establish short- and long-term goals for relationshipClient moves into incubatorThe information you share with us will remain confidential.
