Grind + Growth FastTrac® NewVenture™ training

1
Entrepreneur's Name* This field is required.
First Name
Middle Name
Last Name
2
E-mail* This field is required.
3
Phone Number* This field is required.
Area Code
Phone Number
4
What is the highest degree or level of school you have completed? (If you’re currently enrolled in school, please indicate the highest degree you have received)* This field is required.
Less than a high school diploma
High School degree or equivalent (e.g. GED)
Some college, no degree
Associate degree (e.g. AA, AS)
Bachelor's Degree (e.g.BA, BS)
Master's degree (e.g. MD, DDS, DVM)
Professional Degree (e.g. MD, DDS, DVM)
Doctorate (e.g. PhD, EdD)
5
What was your total income before taxes during the past 12 months? [Optional]
Less than $25,000
$50,000 to $74,999
$25,000 to $34,999
$75,000 to $99,999
$35,000 to $49,000
$100,000 to $149,999
$150,000 or more
6
What stage is your business in?* This field is required.
Pre-Startup (No sales)
Startup (Sold goods/services for less than 1 year)
Operating (Sales for 1+ years)
7
Business Name (if applicable)
8
Business Address-Street, City (Please use your home address if your business has not launched.* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
9
Business Website (if applicable)
10
What industry do you plan for your business to be in?* This field is required.
Accommodation and Food Services
Administrative and Support and Waste Management and Remediation Services
Agriculture, Forestry, Fishing and Hunting
Arts, Entertainment, and Recreation
Construction
Educational Services
Finance and Insurance
Health Care and Social Assistance
Information
Management of Companies and Enterprises
Manufacturing
Mining, Quarrying, Oil and Gas Extraction
Other Services (except Public Administration)
Professional, Scientific, and Technical Services
Public Administration
Real Estate and Rental and Leasing
Retail Trade
Transportation and Warehousing
Utilities
Wholesale Trade
Other
11
What is your most immediate business concern? (Select all that apply)* This field is required.
Identify my business idea
Test my product/service
Research customers
Research competitors
Develop a financial plan
Other (please specify)
Develop a business plan
Access financing
Secure permits/licenses to operate
Launch my business
Register my business
12
Briefly describe your business idea. (minimum 50 words)* This field is required.
13
How do you think FastTrac and Grind + Growth will help you launch your business (minimum 50 words)* This field is required.
Huge
Large
Normal
Small
Ok
Ok
14
How did you learn about Grind + Growth?* This field is required.
Social Media (Facebook, Twitter, LinkedIn, etc.)
Print (newspaper, magazine, etc.)
Television
Radio
Internet (Google news, publication website, etc.)
People (family, friends, co-workers, etc.)
Professional Association
Non-Profit/Community-Based Organization
15
What is your gender? [optional]
Male
Female
16
What is your race or ethnicity? (Select all that apply) [optional]
American Indian
Hispanic
Asian/Pacific Islander
Black or African American
White/Caucasian
Other
17
What is your age? [optional]
18-24
25-34
35-44
45-54
55-64
65+
18
What is your employment status? (select all that apply)* This field is required.
I run my own business
I am employed full-time
I am an aspiring entrepreneur
I am employed part-time
I am not employed but looking for work
I am retired
I am a student
I am not employed and not looking for work
19
Have you served at last one day in the active U.S. military, naval, or air service, including the Reserves and National Guard?* This field is required.
YESNO
20
Will your business be Minority-owned:* This field is required.
YESNO
21
Will your business be Woman-owned:* This field is required.
YESNO
22
Will your business be Veteran-owned:* This field is required.
YESNO
23
Will your business be Service-disabled veteran-owned:* This field is required.
YESNO
24
Will your business be worker-owned:* This field is required.
YESNO
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