2023 EmPOWERED to Serve Business Accelerator™

2023 EmPOWERED to Serve Business Accelerator™

MINNESOTA APPLICATION
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
I am applying as*

IndividualOrganization/Company/Social Enterprise
What is the name of your organization/business?*
Are you applying with an idea or are you applying as an established organization ?*

IdeaEstablished Organization
What is the name of the program or project you are submitting to the accelerator? (If you have a large organization, choose one program that you would like to focus the training and grant dollars towards.)
What do you or your organization do? *
Does your organization serve communities in Minnesota?*

YesNo
What cities/counties does your program/project impact?
Do you operate in other states/cities?

YesNo
If yes, where? Type here .
What is your business model?
How does your program/project currently help improve the health of the communities in which it reaches? *
What makes you passionate about your submission and why are you personally committed to its success?
How does your background or journey relate to your work?
What makes you believe you will be successful?
Estimate the impact of your project using a combination of numbers and descriptors (ex: how many people it reaches, health impact data, amount of food rescued, etc.).
What’s new or interesting about what you are doing?
What health gap/disparity are you addressing?*
Type here.
What organizations are doing something similar? What new angle or extra support are you bringing to the issue?
What do you understand about this project and community that other people don't get?
If you were to receive the grant funding, what would you use it for?*
Video Submission
While a video is optional, it maybe influential in our decision-making. Please consider submitting a video. Enter the URL of a one-minute, unlisted (not private)YouTube video introducing yourself and your team and a brief synopsis of your project.
Company Website - enter a valid website URL for example http://www.google.com
Please share your social media platform URL's and followers. (example https://www.facebook.com/EmPoweredToServe/1000 followers)
What is the size of your organization?*

0-10 Employees11-50 Employees51-200 Employees200 + Employees
Does your organization have volunteer opportunities?

YesNo
Please share the volunteer opportunities.
Have you worked in any capacity with the American Heart Association (AHA) and/or received prior funding from the AHA? If so, please describe
Does your concept/submission have a patent?

YesNo
Is your patent currently being challenged or are you in current litigation with other organizations or entities?

YesNo
Request for Award Terms and Conditions. Please click on this hyperlink to find our Terms and Conditions. Then indicate below that you have read, reviewed, and accepted the Request for Award Terms and Conditions.
By checking the box, you are agreeing to be bound to the terms and conditions of this grant award if selected by AHA.*

YesNo
Gender*

FemaleMaleTransgender FemaleTransgender MaleNon- BinaryOtherPrefer not to answer
Race*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian/Pacific IslanderWhiteOtherPrefer Not to Answer
Ethnicity*

Hispanic or LatinoNot Hispanic or LatinoPrefer not to answer
Would you like to be informed when other EmPOWERED to Serve opportunities are available through the e-newsletter?

YesNo
How did you hear about applying to the EmPOWERED to Serve Business Accelerator?

WebsiteSocial MediaAHA WebsiteAHA staffOther WebsiteFriends or FamilyOther (fill in the blank)
Type here.
Type here .
Should be Empty:

2023 EmPOWERED to Serve Business Accelerator™

Video Submission