MyBusiness Startup to Product: Intake Form

Application Deadline for Fall Session is September 30th, 2016

This program includes intensive entrepreneurial training and is designed for women in the early stages of starting a product-based business, with sessions designed to hone your concept, gain consumer feedback and insight into marketing and distribution, and learn to effectively pitch your business. The program will be facilitated by Co-Owner and Founder Meredith Meyer Grelli, MBA, of the award-winning Pittsburgh startup Wigle Whiskey.

At the end of this program, participants will have a concise business plan, a vision for their business moving forward, and will be given an opportunity to pitch for funding, partnership, or other opportunities identified during the final session in front of a panel of regional stakeholders. Participants will also have access to networking opportunities and educational resources through the Center for Women’s Entrepreneurship.

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* 1. Tell us about yourself:

First and Last Name:

Email Address:

Phone Number:

Mailing address (include city, state, zip):

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* 2. Tell us about your business:

Have you started the business for which you are seeking assistance?

Please provide your business name:

Please provide your business address:

Please provide your business website (if any):

Please provide 1-3 primary markets for your business:

Please provide your business description and type of industry:

Please provide the number of employees (excluding yourself):

If you haven't started a business yet, please explain your business idea or concept:

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* 3. Please provide a brief description of your professional background, including any entrepreneurial experience and previous experience you have working with start-ups.

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* 4. Tell us more about what you have accomplished so far:

Are you interested in applying to an accelerator?

If yes, when and why did you apply?

If you applied and weren't selected, will you apply again?

Have you received any external funding for your business to date? (loans, grants, crowdfunding etc)

If yes, what kind of funding did you receive and how did you utilize that funding?

Are you interested in external funding? What kind, and what would you like to accomplish with that funding?

Do you have a prototype, design, sketch, or sample of your product? If so, please describe.

What are your growth goals; how large would you like to become in terms of employees, distribution footprint, and/or revenue?

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* 5. Please select three main areas in which you feel your business needs the most assistance.

Strategy (vision, mission, planning)

Finance (financial systems, bookkeeping, budgeting, projections, turnover, cash flow)

Capital (equity and debt financing to grow your business)

Product Development (new or better products)

Marketing/Communications (customer loyalty/base, new markets, visibility, social media)

Sales (sales volume, merchandising, pricing, margins)

Operations and/or Production (production methods, administration, waste, downtime, inventory, Six Sigma)

Globalization (outsourcing, importing, exporting)

Legal (reorganizing, drafting contracts, certifications, regulatory compliance)

Intellectual Property (patents, copyrights, trademarks)

Consumer/Market Research (focus groups, consumer feedback)

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* 6. Do you have any other comments, questions, or concerns?

The Center for Women's Entrepreneurship at Chatham University understands that any information you disclose in this form is both confidential and proprietary and will only be used for evaluating your entry into the MyBusiness Startup to Product Program.