New Customer Registration Form

Name*

FirstLast
Email*
ex: email@yahoo.com
Company Name*
Job Title*
Location*

Street Address

Street Address Line 2

CityState

Zip Code
Years of full-time work experience*
Please share your LinkedIn profile link*
How did you hear about this opportunity?*
Why are you interested in becoming a Corporate Ambassador for Upaya? (Optional, but a brief and honest response is appreciated)
What causes are you most passionate about? (Check all that apply)*

Poverty AlleviationJob CreationImpact InvestingSocial EntrepreneurshipWomen's EmpowermentEnvironmental SustainabilityOther
What nonprofits have you supported or volunteered with before? (Please mention "None" if you have not)*
What do you hope to gain from being an Upaya Corporate Ambassador? (Check all that apply)*

Professional networkingDeeper understanding of impact investingMaking a tangible social impactLeadership experienceExclusive access to Upaya's community and eventsOther
What channels are you most comfortable using to promote Upaya's mission? (Check all that apply)*

Internal company platforms (e.g., Slack, Yammer)Professional social media (e.g., LinkedIn)Personal social media (e.g., Instagram, Facebook)Company newsletters or emailsIn-person conversations with colleaguesNone of the aboveOther
Are you comfortable committing to mobilizing or donating $5,000 or more per year toward Upaya's work?*

YesNoUnsure
Does your company offer a corporate match program for employee donations?*

YesNoUnsure
Have you participated in a company-wide giving campaign or "Giving Week" program before?*

YesNoUnsure
Are you interested in potential opportunities to travel to India with Upaya and other ambassadors to see our work firsthand?*

YesNoMaybe
If you have unanswered questions about Upaya or the program, please let us know!
Thank you for your interest in partnering with us to create dignified jobs and empower underprivileged communities in India. Your passion can help families increase their income, save for the future, send their children to school, and break out the vicious cycle of poverty.
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