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27
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1
Which Alloy Growth Lab program are you interested in applying for?
*
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Select multiple options if necessary
Morning Mentoring
Office Space/Lab-Space/Flex-Space
CoWorks, Virtual Office
Open Office Session - 30 min session
Not Sure - please follow-up
Morning Mentoring
Office Space/Lab-Space/Flex-Space
CoWorks, Virtual Office
Open Office Session - 30 min session
Not Sure - please follow-up
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2
Company Name
*
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3
Name
*
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First Name
Last Name
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4
Email
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5
Phone Number
*
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6
Date Company was Established?
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Date
Year
Month
Day
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7
Business Structure
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Sole Proprietor
Partnership
C Corporation
S Corporation
Limited Liability Partnership
Limited Liability Company
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8
Federal Employer Identification Number
Leave blank if you do not have this for your business
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9
Website
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10
Social Media
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Facebook URL
Twitter Handle
LinkedIn URL
Other
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11
Company Description
*
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50 words or less
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12
Do you have a pitch deck? Upload here.
Not required - but companies with a pitch deck will be given priority consideration.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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13
What Stage of Development is Your Business?
*
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Check all that apply
Ideation
Minimum Viable Product
Operational - less than 1 year
Operational - more than 1 year
Paying Customers
Scaling
Successful Capital Raise
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14
The Problem
*
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What are you solving?
0/150
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15
The Solution
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Why is it unique or revolutionary? What is your value proposition?
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16
The Market
*
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Why is it the right time and who is your customer? Who are your partners? What does the competition look like? What is the size of the opportunity? Do you (or teammate) have experience in that market or industry?
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17
The Revenue Model
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How are you going to make money?
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18
The Team
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Why can you and your team execute? What makes the founders tick? What are the unique strengths that each member brings to the team?
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19
Success
*
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What does success look like for your company? What milestones do you want to achieve - short-term and long-term?
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20
The Ask
*
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Why do you want to work with the Alloy Growth Lab?
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21
Last Fiscal Year Revenue
*
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Type "0" if none
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22
Business Owned By
*
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Female 100%
Male 100%
Female at least 51%
Male at least 51%
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23
Minority Owned Business
*
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YES
NO
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24
Considering the Chairman, CEO, President leadership positions or company ownership in excess of 30%, please note representation from a race and ethnicity standpoint:
*
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Either one or more of the stated leadership positions or an ownership position above threshold meets the State of Ohio definition of representation.
Hispanic, Latino, or Spanish Origin
American Indian or Alaska Native
Asian/Asian Indian
Black or African American
Native Hawaiian or Other Pacific Islander
White
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25
How Did You Hear About the Alloy Growth Lab?
*
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Social Media
Event
Web
Word of Mouth
Print
TV, Radio
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26
Signature
*
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The information in this application is provided for the purpose of applying to the Alloy Growth Lab. Additionally, I grant permission to the Alloy Growth Lab, the unrestricted right to reproduce the photographs and/or video images taken of me for the purpose of publication, promotion, illustration, advertising, or trade in any manner or in any medium. Furthermore, I grant permission to use my statements that were given during Alloy Growth Lab events with or without my name, for the purpose of advertising and publicity without restriction.
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27
Signature Date
*
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-
Date
Year
Month
Day
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