WOMEN'S BUSINESS ACCELERATOR APPLICATION FORM

WOMEN'S BUSINESS ACCELERATOR APPLICATION FORM
*Please note that our fall application period is closed. The next Women's Business Accelerator Program will take place from January 10- February 23, 2022.*

We will review your application in the winter and contact you about next steps at that time. Thank you for submitting an application!
PERSONAL CONTACT INFORMATION

Thanks for applying
First Name *
First Name
Last Name *
Surname
Date of Birth *

Month Day Year
Email *
example@example.com
Cell Phone *
Please enter a valid phone number.
Home/Other Phone
Please enter a valid phone number.
Residential Address *
Unit, Number, Street
City *
Postal Code *
Example: M4T 1Z6
Province *
How did you hear about this program? *
Community Agency/Other (please specify referral source here)
What is your status in Canada? Please note: proof of status will be required as part of eligibility for the program (i.e. PR card, Notice of Decision etc.) *

Permanent Resident Convention Refugee/Protected Person Live-in caregiver (work permit)
How long have you been in Canada? *

Under 1 year 1-5 years 6-10 years More than 10 years
What is your country of origin? *
Country of Origin
Which race category/categories best describes you? *

Aboriginal/Indigenous Black-(African, Afro-Caribbean, African-Canadian descent) East Asian (Chinese, Korean, Japanese, Taiwanese descent) Latino-(Latin American, Hispanic descent) Middle Eastern-(Arab, Persian, West Asian descent, e.g. Afghan, Egyptian, Iranian, etc.) Multiracial/Ethnic South Asian-(South Asian descent, e.g. Indian, Pakistani, Sri Lankan, Bangladesh, Indo-Caribbean, etc.) Southeast Asian-(Filipino, Vietnamese, Cambodian, Thai, other Southeast Asian descent) White (Caucasian)-(North American, European descent) Another race category Prefer not to say
If you selected another race category above, please specify it here.
Level of Education *

No formal education Primary Secondary College or undergraduate Postgraduate
English Language and Communication Skills *

Excellent Good Not-so-good
Employment status *

Full time Part time Self-employed Not employed Student
Business Ideas and Experience

We strongly encourage applicants to have at least one business idea they want to focus on and develop through this program. This could be a previous or new idea.
Do you have a business idea? *

Yes No
Briefly describe your idea or ideas (top two if you have more than one idea) *
Description of business idea(s)
Have you owned and ran a business OUTSIDE Canada? *

Yes No
Have you owned and ran a business IN Canada? *

Yes No
Business website/social media links, if applicable.
Business links
Have you previously participated in a business training program in Canada? *

Yes (provide name below) No
If you answered yes above, name of organization
Have you previously received business or professional coaching or mentorship? *

Yes No
Briefly tell us what you hope to gain from this program. *
Program Attendance and Participation

This program will be offered online via Zoom.
Are you committed and able to attend the program sessions? *

Yes No
Do you have access to a computer and reliable internet? *

Yes No
What may affect your ability to attend and complete the program? e.g. employment, school, childcare, the time of sessions, etc. *
Media Consent and Release

As part of the program, we often do feature stories and profile our clients and their businesses. We would like your consent to share any content of those stories.
Do you authorize ACCESS Community Capital Fund to use your images or video footage, in whole or in part, individually or in conjunction with other images and video footage, to be displayed on its website and other official channels, and to be used for media purposes including promotional presentations and marketing campaigns? You agree to waive rights to privacy and compensation, which you may have in connection with such use of your name and likeness, including rights to written copy that may be created in connection with video production, editing and promotion therewith. *

I agree I do not agree
Today's Date *

Month Day Year
Today's Date
Signature *

Clear
Should be Empty:

WOMEN'S BUSINESS ACCELERATOR APPLICATION FORM

*Please note that our fall application period is closed. The next Women's Business Accelerator Program will take place from January 10- February 23, 2022.*

PERSONAL CONTACT INFORMATION

Business Ideas and Experience

Program Attendance and Participation

Media Consent and Release

Please note that our fall application period is closed. The next Women's Business Accelerator Program will take place from January 10- February 23, 2022.