Multicultural Catalyst Fund Interest Form

Multicultural Catalyst Fund Interest Form
Thank you for your interest in the Multicultural Catalyst Fund. This fund is for loan requests of up to $100,000.

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.

NOTE: please be aware that to qualify for a Mountain BizWorks loan, your business must be based in Western North Carolina.
What county is (or will be) the business based in?*
We're sorry, at this time we are only able to provide financing in the WNC region. Click here to find a CDFI near you.
Personal Information
Name*

First NameLast Name
Email Address*
Phone Number*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Demographic Information

The following information is requested as an effort to further understand the needs of small business owners. You are not required to furnish this information, but you are encouraged to do so. If you do not wish to furnish the following information, select the 'Prefer not to answer' option. Mountain BizWorks does not discriminate on the basis of this information, nor on whether you choose to furnish it.
How would you describe your race?*

AsianLatinoBlack or African AmericanNative AmericanWhiteMulti-RacialUnknown / Not StatedPrefer not to answerOther
How would you describe your gender identity?*

FemaleMaleNonbinaryPrefer not to answerOther
Current Military Status*

Non-Veteran/Non-MilitaryVeteranService-Disabled VeteranNational Guard/ReserveActive DutyUnknown/Not StatedPrefer not to answer
Are you from a low income household or community?*

YesNoUnsurePrefer not to answer
Primary Language*

EnglishSpanishPrefer not to answerOther
Please select the age range that applies to you:*

Under 1818-2425-3435-4445-5455-6465 or older
Date of Birth

MonthDayYear
Date
Business Information
Business Name (if applicable)*
What amount of funding are you requesting?*

Less than $5,000$5,000 - $9,999$10,000 - $24,999$25,000 - $49,999$50,000 - $99,999$100,000 or more
Funding Amount Requested
Please enter a number between 500 - 100,000
Business Stage - Please select the current stage of your business:*

Ideation/Pre-revenue: I have not started selling yetStartup: I have started selling my product(s)/service(s)Early stage: My revenue is increasing and I am able to keep up with the demandScaling 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-tuningExiting: I want to exit by selling or closing my business or converting ownership
Describe your intended use of the funds.*
Should be Empty:

Multicultural Catalyst Fund Interest Form

Personal Information

Demographic Information

Business Information