Contact
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What organization did you receive the invitation from?
*
Please Select
The Fourth Effect in the 49th
BeeLoud
Executive Council Network
Innovation Space
Founder Institute
INNOVIT
MassChallenge
KiwiTech
Nest Catalyst
Stella
NYSERDA
Bay Angels
SkyDeck
OpenGrants
Other
Back
Next
Save
Company
Company Name
*
Company Website (Include http://www.)
*
Industry
*
Animals/Pets
Consumer Packaged Goods
Entertainment
Social Impact
Community Service
Hospitality
Human Resources
Law Practice
Legal Services
Life Sciences
Luxury Goods & Jewelry
Manufacturing
Market Research
Real Estate
Accounting
Alternative Dispute Resolution
Alternative Medicine
Animation
Apparel & Fashion
Architecture & Planning
Arts & Crafts
Automotive
Aviation & Aerospace
Banking
Biotechnology
Branding
Broadcast Media
Business Consulting and Services
Building Materials
Business Supplies and Equipment
Cannabis/CBD
Capital Markets
Chemicals
Civic & Social Organization
Civil Engineering
CleanTech
Commercial Real Estate
Community Building
Computer & Network Security
Computer Hardware
Computer Networking
Computer Software
Construction
Consumer Electronics
Consumer Goods
Consumer Services
Cosmetics/Beauty
Cybersecurity
Dairy
Data
Defense & Space
Design
Education Management
E-Learning
Electrical/Electronic Manufacturing
Environmental Services
Events Services
Executive Office
Facilities Services
Farming
Financial Services
Fine Art
Fishery
Food & Beverages
Food Production
Fund-Raising
Furniture
Gambling & Casinos
Gaming
Glass/Ceramics/Concrete
Government Administration
Government Relations
Graphic Design
Health/Wellness/Fitness
Higher Education
Hospital & Health Care
Import and Export
Individual & Family Services
Industrial Automation
Information Services
Information Technology & Services
Insurance
International Affairs
International Trade and Development
Internet
Investment Banking
Investment Management
Judiciary
Law Enforcement
Legislative Office
Leisure/Travel/Tourism
Lending/Mortgages
Libraries
Logistics and Supply Chain
Machinery
Management/Operations Consulting
Maritime
Marketing and Advertising
Mechanical or Industrial Engineering
Media Production
Medical Devices
Medical Practice
Military
Mining & Metals
Motion Pictures and Film
Museums and Institutions
Music
Nanotechnology
Newspapers
Nonprofit Organization Management
Oil & Energy
Online Media
Outsourcing/Offshoring
Package/Freight Delivery
Packaging & Containers
Paper & Forest Products
Performing Arts
Pharmaceuticals
Philanthropy
Photography
Plastics
Political Organization
Primary/Secondary Education
Printing
Privacy & Data Security
Professional Training & Coaching
Program Development
Public Policy
Public Relations and Communications
Public Safety
Publishing
Railroad Manufacture
Ranching
Raw Materials
Recreational Facilities and Services
Religious Institutions
Renewables/Environment/Sustainability
Research
Restaurants
Retail
Security and Investigations
Semiconductors
Shipbuilding
Sporting Goods
Sports
Staffing & Recruiting
Strategy
Supermarkets
Telecommunications
Textiles
Think Tanks
Tobacco
Translation and Localization
Transportation/Trucking/Railroad
Utilities
Venture Capital
Private Equity
Veterinary
Warehousing
Wholesale
Wine and Spirits
Wireless
Writing and Editing
Proptech
Adtech
Agtech
AI
Arttech
Blockchain
CaaS (Community as a Service)
Edtech
Famtech
Femtech
Fintech
Healthtech
Legaltech
Martech
SaaS
Customer Relationship Management (CRM)
Retail Tech
Internet of Things (IoT)
Technology
Cosmetics/Beauty/Beauty
Professional Services
Crypto/NFTs
Information Technology
Finance
Community Building
Renewables/Environment/Sustainability
Organization Size
*
Please Select
1-2
3-10
11-50
51-200
201-500
501-1000
1001-5000
5001-10000
10001+
Development Stage/Growth Stage
*
Please Select
Idea Stage
Proof of Concept
Angel Round (Raising your first equity capital)
Beta Testing/Pre-revenue
Product in-market & generating revenue
Seed Round (in the process of raising $50K - $1.5MM)
Post-Seed Round (your seed round is closed)
Series A Funding: First round of VC
Post-Series A
Pre-seed
Other
Headquarters (city, state, country)
*
Description (800 chars max)
*
Company Logo (100MB Max)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
Save
Specifics
Founded Date
*
 -
Month
 -
Day
Year
Date
Primary Product/Service Offered
*
SaaS
Software
Hardware
Physical products
Mobile apps
Other
Projected Annual Revenue 2024
*
Please Select
$0-$100k
$101k-$500k
$501k-$1MM
$1MM-$5MM
$5MM-$10MM
$10MM-$50MM
$50MM-$100MM
$100MM-$500MM
$500MM-$1B
$1B-$3B
$3B+
Confidential
How have you funded your business to date? (Select all that apply)
Profitable
Self-Funded/Bootstrapped
Friends and Family
Angels
Grants/Non-Dilutive Capital
Debt/Bank Loan
Venture Capital
Private Equity
Primary Business Model
*
B2B
B2C
B2B2C
C2C
C2B
Other
US Corporate Structure
*
Please Select
LLC
S-corp
C-corp
B-corp
Unincorporated
Incorporated outside of the US
Other
Back
Next
Save
Do you have any patents or other IP protection over any of your products or technology?
One or more patents and/or patents pending
Other IP protection
No patents or other IP protection
Do you have plans to substantially scale your business in the next 12-36 months?
Yes
No
Has your company developed a scalable solution to address a problem or pain point in your industry?
Yes
No
Does your solution leverage a technology-enabled platform that delivers a service or product to customers in your industry?
Yes
No
Has your company been subject to any lawsuits?
Yes
No
Have you or anyone on your founding team participated in any other incubator/accelerator programs?
Yes
No
Do you anticipate M&A activity in the near future?
Yes
No
Are you currently or do you anticipate fundraising in the near future?
Yes
No
What countries do you operate in? Please list all
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
If you would like to select multiple choice, please hold down CTRL button.
What has been a great success in your business of which you are proud?
What is a significant challenge that you would like to immediately address in your business?
Board Opportunity
In order to be eligible to participate in this Fellowship, all companies must be committed to diversity at the board level and therefore willing to post at least one board opportunity on the Board Seat Exchange along with this application. However, there is no obligation to fill the position with someone in our platform. Please provide details below.
Board Opportunity Type
*
Advisor
Independent Board Director
Board Observer
Angel Advisor (Advisor who will also make an angel investment)
Pro Bono Advisor
Short description (300 characters or less)
What industry experience are you looking for in a mentor, advisor, director?
*
Animals/Pets
Consumer Packaged Goods
Entertainment
Social Impact
Community Service
Hospitality
Human Resources
Law Practice
Legal Services
Life Sciences
Luxury Goods & Jewelry
Manufacturing
Market Research
Real Estate
Accounting
Alternative Dispute Resolution
Alternative Medicine
Animation
Apparel & Fashion
Architecture & Planning
Arts & Crafts
Automotive
Aviation & Aerospace
Banking
Biotechnology
Branding
Broadcast Media
Business Consulting and Services
Building Materials
Business Supplies and Equipment
Cannabis/CBD
Capital Markets
Chemicals
Civic & Social Organization
Civil Engineering
CleanTech
Commercial Real Estate
Community Building
Computer & Network Security
Computer Hardware
Computer Networking
Computer Software
Construction
Consumer Electronics
Consumer Goods
Consumer Services
Cosmetics/Beauty
Cybersecurity
Dairy
Data
Defense & Space
Design
Education Management
E-Learning
Electrical/Electronic Manufacturing
Environmental Services
Events Services
Executive Office
Facilities Services
Farming
Financial Services
Fine Art
Fishery
Food & Beverages
Food Production
Fund-Raising
Furniture
Gambling & Casinos
Gaming
Glass/Ceramics/Concrete
Government Administration
Government Relations
Graphic Design
Health/Wellness/Fitness
Higher Education
Hospital & Health Care
Import and Export
Individual & Family Services
Industrial Automation
Information Services
Information Technology & Services
Insurance
International Affairs
International Trade and Development
Internet
Investment Banking
Investment Management
Judiciary
Law Enforcement
Legislative Office
Leisure/Travel/Tourism
Lending/Mortgages
Libraries
Logistics and Supply Chain
Machinery
Management/Operations Consulting
Maritime
Marketing and Advertising
Mechanical or Industrial Engineering
Media Production
Medical Devices
Medical Practice
Military
Mining & Metals
Motion Pictures and Film
Museums and Institutions
Music
Nanotechnology
Newspapers
Nonprofit Organization Management
Oil & Energy
Online Media
Outsourcing/Offshoring
Package/Freight Delivery
Packaging & Containers
Paper & Forest Products
Performing Arts
Pharmaceuticals
Philanthropy
Photography
Plastics
Political Organization
Primary/Secondary Education
Printing
Privacy & Data Security
Professional Training & Coaching
Program Development
Public Policy
Public Relations and Communications
Public Safety
Publishing
Railroad Manufacture
Ranching
Raw Materials
Recreational Facilities and Services
Religious Institutions
Renewables/Environment/Sustainability
Research
Restaurants
Retail
Security and Investigations
Semiconductors
Shipbuilding
Sporting Goods
Sports
Staffing & Recruiting
Strategy
Supermarkets
Telecommunications
Textiles
Think Tanks
Tobacco
Translation and Localization
Transportation/Trucking/Railroad
Utilities
Venture Capital
Private Equity
Veterinary
Warehousing
Wholesale
Wine and Spirits
Wireless
Writing and Editing
Proptech
Adtech
Agtech
AI
Arttech
Blockchain
CaaS (Community as a Service)
Edtech
Famtech
Femtech
Fintech
Healthtech
Legaltech
Martech
SaaS
Customer Relationship Management (CRM)
Retail Tech
Internet of Things (IoT)
Technology
Cosmetics/Beauty/Beauty
Professional Services
Crypto/NFTs
Information Technology
Finance
Community Building
Renewables/Environment/Sustainability
Skills and expertise sought
Communications
Communications - Audience Building
Communications - Branding
Communications - Client Acquisition
Communications - Community Building
Communications - Community Outreach
Communications - Content Marketing
Communications - Convention Planning
Communications - CPG
Communications - Customer Service
Communications - Digital Marketing
Communications - DTC
Communications - E-Commerce
Communications - Investor Relations
Communications - Journalism
Communications - Marketing
Communications - Media Relations
Communications - Personnel & Management
Communications - Public Relations
Communications - Public Speaking
Communications - Telecommunications
Communications - UGC
Current or Former Executive of Large Private Multinational
Current or Former Executive of Publicly Listed Company
Current or Former Executive Role in Government Organization
Current or Former Executive Role in Health
Current or Former Executive Role in Safety
Current or Former Executive Role in Workplace Environment
Current or Former Role in Finance Industry
Current or Former Role in Fund Management
Current or Former Role in Government
Current or Former Role in Insurance
Current or Former Role in Manufacturing Sector
Environmental/Social - Agriculture Industries
Environmental/Social - Global Environmental Management
Environmental/Social - Hospitality Industry Experience
Environmental/Social - Non-Profit Experience
Environmental/Social - Sustainability Executive
Environmental/Social Experience
Finance
Finance - Accounting
Finance - Audit & Risk
Finance - Auditing
Finance - Auditing Partner Experience
Finance - C.A.
Finance - C.F.A.
Finance - C.F.O
Finance - C.P.A.
Finance - Consumer Finance/Lending
Finance - Current or Former Role in Banking
Finance - Financial Literacy
Finance - Governance Related Risk Management
Finance - M.B.A.
Finance - Risk Management
Finance - Risk Management Systems
Finance - Startup Financing
Finance - Underwriting
General - Business Development
General - Education/Training
General - Research
General - Scaling/Growth
Health - Corporate Healthcare
Health - Corporate Wellness
Health - Digital Health
Health - Health Committee Experience
Health - M.D.
Health - Mental Health
Health - Women's Health
Health & Safety
Health & Safety - HR Executive
Health & Safety - Human Resource Management
Health & Safety - Human Resources
Health & Safety - Safety Committee Experience
Health & Wellness
Healthcare
Healthcare B2B Sales
International Markets - Advisory Role in Overseas Market
International Markets - Executive Role in Overseas Market
International Markets - Knowledge of Overseas Market
Legal
Legal - Current or Former General Counsel
Legal - Current or Former Law Firm Partner
Legal - Current or Former Practicing Lawyer
Legal - Intellectual Property
Legal - J.D.
Legal - Patent Law
Legal - Securities Law
Legal - WFOE Legal Expertise
M&A Experience
M&A/Capital Markets
M&A/Capital Markets - Capital Raising Experience
M&A/Capital Markets - Current or Former Corporate Advisory Role
M&A/Capital Markets - Fundraising
M&A/Capital Markets - Funds Management
M&A/Capital Markets - Investment Banking
Manufacturing/Supply Chain
Manufacturing/Supply Chain - B2C Sales
Manufacturing/Supply Chain - Consumer
Manufacturing/Supply Chain - Fashion Industry Operations
Manufacturing/Supply Chain - Fashion/Textile Supply Chain
Manufacturing/Supply Chain - FMCG
Manufacturing/Supply Chain - Hardware Manufacturing
Manufacturing/Supply Chain - Industrials
Manufacturing/Supply Chain - Information Management
Manufacturing/Supply Chain - Innovative Mills
Manufacturing/Supply Chain - Logistics
Manufacturing/Supply Chain - Luxury Goods
Manufacturing/Supply Chain - Niche Consumer Goods
Manufacturing/Supply Chain - Niche Products
Manufacturing/Supply Chain - Pricing
Manufacturing/Supply Chain - Product Development
Manufacturing/Supply Chain - Product Distribution
Manufacturing/Supply Chain - Product Marketing
Manufacturing/Supply Chain - Product/Service Design
Manufacturing/Supply Chain - Resources
Manufacturing/Supply Chain - Retail & Wholesale Business Experience
Manufacturing/Supply Chain - Sales
Manufacturing/Supply Chain - Sales Insight
Manufacturing/Supply Chain - Sign Design & Interpretation
Manufacturing/Supply Chain - Sourcing
Manufacturing/Supply Chain - Store Planning
Manufacturing/Supply Chain - Textile Operations
Manufacturing/Supply Chain - Wholesale & Retail Buyer Connections
Public Policy/Legislative - Compliance
Public Policy/Legislative - Public & Private Sector Experience in Economic Policy
Public Policy/Legislative Experience
Senior Executive - CEO/Senior Management Experience
Senior Executive - Director - Large Organization (100+ Employees)
Senior Executive - Director - Medium Organization (10-99 Employees)
Senior Executive - Executive Performance Management
Senior Eecutive - Performance Management & Improvement
Social Impact
Special Agency Knowledge or Contacts
Strategic Governance
Strategic Partnerships
Strategic Planning
Strategy Development
Technical/Engineering - Electricity Distribution
Technical/Engineering - Electricity Infrastructure
Technical/Engineering - Energy Advisor
Technical/Engineering - Energy Distribution
Technical/Engineering - Energy Transmission
Technical/Engineering - Engineering Degree
Technical/Engineering - Exploration
Technical/Engineering - Gas Distribution
Technical/Engineering - Gas Infrastructure
Technical/Engineering - Infrastructure
Technical/Engineering - Refining
Technical/Engineering - Resource Development
Technical/Engineering - Resource Distribution
Technical/Engineering - Resource Executive
Technical/Engineering - Resource Production
Technical/Engineering - Utilities Executive
Technical/Engineering Experience
Technology
Technology - AR
Technology - Cybersecurity
Technology - Digital Products
Technology - Healthcare
Technology - Immersive Technology SME
Technology - IT
Technology - Mobile
Technology - Multi-Platform Experience
Technology - Retail
Technology - SaaS
Technology - Tech Product Manufacturing
Technology - Virtual Reality
Trade Union Leadership
Workforce Engagement Experience
Workplace Environment Committee
Senior Executive - Performance Management & Improvement
Regulatory Expertise
Regulatory Expertise - O
If you would like to select multiple choice, please hold down CTRL button.
Qualities Sought
Ability and Willingness to Challenge and Probe
Collaborative
Collegial
Commitment to Mission
Developed Sustainable Partnerships
Entrepreneurship
Execution/Follow Through
Geographic Representation
Integrity/High Ethical Standards
Leadership
Listening Skills
Practical
Sound Judgment
Special Agency Knowledge or Contacts
Verbal Communication Skills
Visionary
Willing to Work
Interpersonal Relationships
Established Links/Networks/Contacts
Entrepreneurship Mentorship
Mentorship
Efficiency-Oriented
Sound Judgment
If you would like to select multiple choice, please hold down CTRL button.
Community Connections Sought
Committee Chair Experience
Corporate Connections
Fashion/Performance Apparel Brand Connections
Large Scale Food Company Connections
Media Connections
Philanthropic Connections
Potential Investor Connections
Professional Connections
Religious Connections
Social Connections
If you would like to select multiple choice, please hold down CTRL button.
Travel Expectations
In-person meetings
Remote meetings
Compensation & Services Expectations
Compensated according to industry standard guidelines around performance level/compensation for Advisors.
To be determined on a case by case basis- let's discuss!
Compensated according to industry standard guidelines around performance level/compensation for Directors.
No compensation (E.g. mentor/sponsor relationship).
Flexible
Desired candidate superpower
Additional Information
Back
Next
Save
Executive Nominations
As part of this Fellowship, each participating company must nominate at least one woman who meets the criteria for Executive Membership at The Fourth Effect. You may nominate yourself (if applicable) or executives in your company or greater community. If your company is selected to participate in this Fellowship, your qualified nominees will receive a free annual Executive Membership ($960.00) and be invited to participate in this Fellowship Program. In order to qualify, nominees must be accomplished leaders with an established career and at least 10+ years of professional experience, and they must identify as a woman or non-binary.
Nomination 1 Name
*
Nomination 1 Linkedin
*
Nomination 1 Email
*
Nomination 2 Name
Nomination 2 Linkedin
Nomination 2 Email
Nomination 3 Name
Nomination 3 Linkedin
Nomination 3 Email
Back
Next
Save
Terms
I have read and agree to the Fellowship Terms & Conditions linked on this Fellowship's landing pages.
*
Yes
Save
Submit
Should be Empty: