Multicultural Catalyst Fund Interest Form

Thank you for your interest in the Multicultural Catalyst Fund. This fund is for loan requests of up to $50,000.

The first step to the Multicultural Catalyst Fund application process is to fully complete and submit the inquiry form below. Once submitted, you can expect a response from Jeremiah Robinson, MBW Entrepreneur In Residence, within a couple of days regarding next steps. If you have any questions with the application, please email us at jeremiah@mountainbizworks.org.

Personal Information

Name *

First Name Last Name

Email Address *

Phone Number *

Address *

Street Address

Street Address Line 2

City State

Zip Code

Demographic Information

The following information is required for program reporting and statistical monitoring. Your response to these questions will not affect consideration of your application.

How would you describe your race? *

Asian Latino Black or African American Native American White Multi-Racial Unknown / Not Stated Other

How would you describe your gender identity? *

Female Male Nonbinary Prefer not to answer Other

Current Military Status *

Non-Veteran/Non-Military Veteran Service-Disabled Veteran National Guard/Reserve Active Duty Unknown/Not Stated

Are you from a low income household or community? *

Yes No Unsure

Primary Language *

English Spanish Other

Date of Birth *

Date

Business Information

Business Name *

Funding Amount Requested *

Please enter a number between 500 - 50,000

Business Stage - Please select the current stage of your business: *

Ideation/Pre-revenue: I have not started selling yet Startup: I have started selling my product(s)/service(s) Early stage: My revenue is increasing and I am able to keep up with the demand Scaling up: I want to maximize capacity by condensing outputs so our profit margins and operations increase. Mature: Have achieved a comfortable level of success and am maintaining and fine-tuning Exiting: I want to exit by selling or closing my business or converting ownership

Describe your intended use of the funds. *