2024 RTBI Program Application Form

Welcome to the Amped Business Accelerator Waitlist!

Thank you for your interest in the ABA program! ABA is a year-long program that begins each January. The application process opens in August.

To help you prepare, ABA will hold mandatory information sessions in both March through August for participants interested in joining the incubator.

Please fill out the form below to receive notifications about these information sessions and other ABA updates throughout the year.

We look forward to connecting with you!
- Full Name*
  
  First NameMiddle NameLast Name
- Gender (select all that apply)*
  
  MaleFemaleNon-binaryTransgenderIntersexOther
- Birth Date
  
  MonthDayYear
- Which category (s) best describes you? (select all that apply)*
  
  LGBTQ+ community memberUS VeteranPerson with a disabilityPrefer Not To SayNone Apply
- Are you of Hispanic/Latino/Spanish origin?:*
  
  YesNo
- Please indicate if any of the following identifiers apply to you.*
  
  Black or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderWhiteOther
- Please select your age group*
  
  18-24 Years Old25-34 Years Old35-44 Years Old45-54 Years Old55-64 Years Old65-74 Years Old75 Years Or Older
- Mobile Number*
  
  Area CodePhone Number
- Confirm Mobile Number
  
  Area CodePhone Number
- Phone Number Does Not Match!
- E-mail*
- Confirm Your E-mail*
  example@example.com
- Email does not match!
- Current Home Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- How did you hear about the RTBI Program?*
  
  I'm an Amped Staff/Participant/Volunteer/ParentSimmons College Applicant Sherrod LedotTV/NewspaperSocial Media (Facebook, Instagram, Twitter, etc.)Word Of MouthFamily MemberFriendAmped Staff MemberAmped WebsitePrevious RTBI ParticipantLouisville Urban LeagueSmall Business Development Center ( SBDC)Other
- Name of Employee
- Name of Family Member
- Name of Friend
- Name of Staff Member
- Name of RTBI Participant
- Name of LUL Employee
- Name of SBDC Employee
- Name of "Other"
- Name of Your Business (Which business are you applying for RTBI under?)*
  You may only apply under one business
- Do you currently have employees (this includes part time, full time and contracted)*
  
  YesNo
- Co-Owner email
  example@example.com
- Co-Owner Phone Number
  
  Area CodePhone Number
- Business Address (This can be a brick and mortar or the address your registered with the secretary of state including coworking space, at home business address)*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Business Industry (check all that apply):*
  
  Accommodation ServicesAdvisory and Financial ServicesAgriculture, Forestry, Fishing and HuntingArts, Entertainment and RecreationBusiness FranchisesConstructionConsumer Goods and ServicesEducational ServicesFinance and InsuranceFood ServicesHospitality ServicesHealthcare and Social AssistanceIndustrial Machinery, Gas and ChemicalsInformation and Technology ServicesLife SciencesManufacturingMiningOnline RetailProfessional and/or Technical ServicesReal Estate, Rental and LeasingRetail and/or fashionSpecialist Engineering, Infrastructure and ContractorsTransportation and WarehousingUtilitiesWaste Management ServicesBeauty and WellnessConsultingLife CoachCommunity ServicesApparelPromotional Products, Embroidery ApparelCommunity OrganizationSocial ServiceTechnologyTransportationEntertainmentEducationalChild CareSportsMediaDistributionShippingAdult BeverageOther
- Are you?*
  
  Pre-Venture (Ideation Stage)Startup less than 2 years (Have product working to build market)Existing Business More than 2 years (in growth mode-revenue generating)?
- Is your business a for-profit business or a non-profit business?*
  
  For-ProfitNon-Profit
- When was your business incorprated legally?*
  
  MonthDayYear
  Date Business Founded
- How is your business incorporated?*
  
  Presently not incorporatedSole-proprietorshipLLCC-CorpS-CorpOther
- Is your business registered with the federal state and local government?*
  
  YesNo
- If no please explain
- Is your business in good standing with the federal state and local government?*
  
  YesNo
- If no please explain
- Would you classify your business as a:*
  
  Minority Owned BusinessWoman Owned BusinessBoth Minority and Woman OwnedOther
- Describe your business venture in 2-3 sentences?*
- What is the problem your business is solving in 2-3 sentences*
- Select which option describes your entrepreneurial journey:*
  
  I'm a full-time entrepreneur, contributing at least 40 hours a week to my businessI'm a full-time employee at another organization and I'm working with my business when I'm not working full-timeI'm not currently employed and I am attempting to get a point to work with my business full-timeI'm seeking to only do my business part-time
- Have you applied for RTBI before?*
  
  YesNo
- What year(s) did you apply?*
  
  2021202220232024
- Is there any other information that you would like to share with us (about you or your business)?
- Did you have any problem while filling out this form? If so, please report it below
- I understand filling out this waitlist does not guarantee an interview or acceptance into the RTBI Program.*
  
  Yes
- Please verify that you are human*
- Should be Empty: