1.Address

Name

Organization Name

Organization Address

Organization Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Your Email Address

Your Phone Number

2.Please describe your organization. (250 words or less.)

3.Please describe the program for entrepreneurs you plan to run over the next year.

Program location

Sector focus area(s) (if any)

Geographic focus (if any)

Unique/Differentiating factors from other entrepreneurship support organizations

Cost to entrepreneurs (either in cash or equity)

Investment you plan to provide to entrepreneurs (either cash or services)

Number of entrepreneurs supported per program

4.What is the impact you hope to make with your entrepreneur support program? If you are successful, what outcome do you hope to achieve? (150 words or less.)

5.Why do you want to support entrepreneurs? Please describe your prior experience supporting and/or investing in entrepreneurs and how you developed your current program. (150 words or less.)

6.Why do you want to be a part of the VilCap Communities initiative in general? Specifically, why do you want to use the peer-selected investment model in your program? (150 words or less.)

7.During the Salt Lake City workshop, each VilCap Communities participant will lead a session for other participants on a topic in which you excel. What do you think you are truly exceptional at? (Recruiting, mentorship, helping entrepreneurs hire, running events, impact assessment?) (150 words or less.)

8.What is the one thing you want to learn from other people like you? (150 words or less.)

9.The VilCap Communities program requires investors willing to pre-commit a minimum of $50,000 in capital to entrepreneurs, allocated through peer selection. While securing this capital is not a prerequisite for the application, have you identified anyone (including your own organization) willing to pre-commit capital? If so, please describe them. (150 words or less.)

10.If selected, who from your team would attend the launch from March 18-22?

What is their name?

What is their role?

What is their email address?