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Export Accelerator Application
Download the
Application Guide
for more information.
1.
Business Information:
Business Name
Address Line 1
Address Line 2
City
State
Zip Code
Website
EIN
Year Established
Number of Full Time Employees
Number of Part Time Employees
2.
Does your business identify as (select all that apply)
Minority Owned
Women Owned
Disability-Owned
Veteran Owned
LGBTQ+ Owned
3.
Please describe your business model, including brief descriptions of the key products and services you provide, your customers, and how you differentiate your offerings.
4.
How much gross revenue did your business generate in each of the following years?
2022
2023
2024
5.
What percentage of your annual gross revenue can be attributed to business outside the US (approximations are fine)?
2022
2023
2024
6.
What is your current export activity?
Domestic sales only, but have received interest from foreign buyers
Domestic sales only, with no received interest from foreign buyers
Both domestic and international sales
7.
PRIMARY PARTICIPANT (Ensure this person will be able to attend all sessions)
First Name
Last Name
Job Title
Email
Phone
8.
SECONDARY PARTICIPANT (Ensure this person will be able to attend all sessions)
First Name
Last Name
Job Title
Email
Phone
9.
COMMITMENT STATEMENT
Check if you agree to the following:
Business commits to send two employees to attend all assigned educational programming
Business commits to complete an export plan by assigned due date
Business commits to provide information to gauge export success progress via survey annually for five years upon program completion
10.
On behalf of our organization, I fully understand the attendance, tuition, and reporting requirements for participation in the Heartland Export Accelerator program. We agree to fulfill those requirements if selected to participate in the program.
Name
Date
11.
For a more intimate learning experience and to foster robust dialogue the program will be limited to five companies (allowing for two representatives from each selected company). If your company is not selected for this cohort, would you like to be considered for subsequent cohorts?
Yes
No
