WOMEN'S BUSINESS ACCELERATOR APPLICATION FORM
PERSONAL CONTACT INFORMATION
Thanks for applying
First Name
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First Name
Last Name
*
Surname
Date of Birth
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-
Month
-
Day
Year
Email
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example@example.com
Cell Phone
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Please enter a valid phone number.
Home/Other Phone
Please enter a valid phone number.
Residential Address
*
Unit, Number, Street
City
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Postal Code
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Example: M4T 1Z6
Province
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Please Select
ON
Other
How did you hear about this program?
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Please Select
ACCESS staff
ACCESS client
Friend
Online (social media/website etc.)
Community agency (please note source below)
Other (please specify below)
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.)
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Permanent Resident
Convention Refugee/Protected Person
Live-in caregiver (work permit)
How long have you been in Canada?
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Under 1 year
1-5 years
6-10 years
More than 10 years
What is your country of origin (nationality)?
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Country of Origin
Which race category/categories best describes you?
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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
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No formal education
Primary
Secondary
College or undergraduate
Postgraduate
English Language and Communication Skills
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Excellent
Good
Not-so-good
Employment status
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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?
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Yes
No
Briefly describe your idea or ideas (top two if you have more than one idea)
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Description of business idea(s)
Have you owned and ran a business OUTSIDE Canada?
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Yes
No
Have you owned and ran a business IN Canada?
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Yes
No
Business website/social media links, if applicable.
Business links
Have you previously participated in a business training program in Canada?
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Yes (provide name below)
No
If you answered yes above, name of organization
Have you previously received business or professional coaching or mentorship?
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Yes
No
Briefly tell us what you hope to gain from this program.
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Program Attendance and Participation
This program will be offered online via Zoom.
Are you committed and able to attend the program sessions?
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Yes
No
Do you have access to a computer and reliable internet?
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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.
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I agree
I do not agree
Today's Date
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-
Month
-
Day
Year
Today's Date
Signature
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Clear
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