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First Name *

Last Name *

Email *

Phone 1 *

Do you have a name for your company yet? If so, what is it? *

Website

Personal/ Business LinkedIn Link *

Personal/ Business Facebook Link *

Personal/ Business Instagram Link *

Address Line 1 *

Address Line 2 *

City *

State/Province *

Zip/Postal Code *

Country *

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Are you currently a member of the National Black MBA Association (NBMBAA)? If not, would you like to become a member? *

How would you like to join The Boost Pad? *

I'm applying as an entrepreneur

I'm applying as a mentor

I'm applying as a subject matter expert

Is your business incorporated? *

YES

NOT SURE

What type of business do you have? *

If other, please specify *

Do you have any other team members? If so, please list their names and titles. *

What is your gender? *

Female

Male

Non-binary

Prefer not to say

What is your race? *

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or other Pacific Islander

White

More than one race

Other

Describe your business. *

What problem does your business solve? *

What is your solution to the problem? *

Describe your ideal customer. *

From the list below, where do you and your venture need the most assistance? *

App Development | Engineering Support | Web Design

Sales | Brand & Marketing Strategy

Fundraising | Capital Raising

Business Advisory | Legal Services

Accounting | Finance Support

Product Development & Implementation

Other

If other, please specify. *

How did you hear about the Boost Pad? *

Do you live in Mecklenburg County? If not what city do you currently live in? *

How much revenue have you generated in the last 12 months? *

We are focused on working with early stage companies that have generated less than $175,000 in gross revenue

How many employees do you expect to hire over the next 3 years? *

None

1-2

3-5

More than 5

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