JULO Strategy CEO Mindset Application

PHASE One-CEO Mindset™ Application

This application is used to determine who is the best fit for our next CEO Mindset cohort, be sure to provide the necessary detail. All of your responses are confidential and will help us to better help you. We know that some of these questions may be very in depth. We have several organizations and individuals who are willing to sponsor or have scholarships for certain individuals that take this course. These generous organizations and individuals need the information to make sure they are investing in the right people that are committed and will use the course wisely going forward. We are honored to have these people who believe in our CEO Mindset program and are willing to invest in bringing out the CEO in YOU! If you cannot answer a question please answer with an N/A. It does NOT mean that you will not be considered.
Getting Started

First of all, how did you find us?
Were you referred to us? Tell us how and/or who?
How were you referred to JULO?*

Action ZoneBridge LocalFAVOB (Florida Association Veteran Owned Businesses)IndividualJULO StrategyLinkedInVeterans FloridaVeteratiWomen's Business CentreEmpowHermentCYBER MONDAYKS Chamber of Commerce
Name:*

First NameLast Name
E-mail*
Mobile Number*
Other Number

Area CodePhone Number
Which number do you prefer?*
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What is your gender?*
Please Select
What is your race/ethnicity?*
Please Select
What is your date of birth (XX/XX/XXXX)?

MonthDayYear
Date
Have you ever served in the military?*
Please Select
Which Branch did you serve?*
Veterans are required to submit a copy of the DD214. Please upload here. If you do not have your DD214, you may obtain one here - https://www.va.gov/records/get-military-service-records/ or obtain a Letter of Service from the Veterans Administration here - www.id.me. Your DD214 must show Member 4 area, Character of Service.

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Do you have a physical or mental impairment which substantially limits you in one or more major life activity; or have a record of having such an impairment; or are regarded as having such an impairment?
How did you hear about JULO Strategy?*
Home Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tell us more about you so we can best understand your background
Which best describes your current employment or status? (Select all that apply.)

Employed Full TimeEmployed Part TimeRetiredSelf Employed Full TimeSelf Employed Part TimeStudentUnemployedPrefer to not answer
Which best describes the highest level of education you have completed?*
Which of the following best describes your annual household income?*
How many people live in your household?*
What is your work and or entrepreneur background and experience? *
Thanks for the information about you. Now, tell us more about your Company
Company*
Position*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company Phone Number*

Area CodePhone Number
Link to Company's Facebook
Link to Company's Instagram
Company URL
What is your company's or what is you goal incorporation date (XX/XX/XXXX)?*
What is the current status of your company?*
What is the legal structure of your company?*
Which of the following best describes the type of venture you anticipate working on in the CEO Mindset program?*
Give a one-paragraph company bio. (How long you've been in business, what services/product you provide, how you got started, etc.)*
What problem does your business solve?*
In what industry would you categorize your Company? *
What do you define as your target market or market segment?*
How much revenue did your company bring in during the last calendar year (number only)?*
What are your current monthly revenues?*
What is (or will be) your primary source of revenue?*
What has been the main source of funding for your business?*
Are you currently seeking funding for your business?*

YesNoPlan to in the next 6 monthsPlan to in the next year
How much funding is your company seeking? *
How much capital, seed or personal funding have you or others invested in your business so far?*
How many hours a week do you plan to work on your business?*
How many employees do you currently have?*

None- JUST ME1 additional2345-1011-1516-2021-3031-4050+
Have you started selling your product or service?*
Has your Business obtained a Business Bank Account?*
Have you applied or have an EIN (Employer Identification Number) from IRS*
What goals do you hope to accomplish during your time in CEO Mindset?
Commitment

Are you ready to commit your time and attention to make significant progress for your venture through CEO Mindset?
There is a fee for participating in this program ALL fees will be due before the first class (select all that apply to you):*

I am able to pay now and secure my seat in the cohort - $1600. Through March 8, 2023 Price is $640 Save 60%I would like to take advantage of the payment plan - 3 payments of $547 eachI am a Veteran and I am able to pay now to secure my seat in the cohort - $600.I am a Veteran and would like to take advantage of the payment plan - 3 payments of $225 each.I would like to know how I can sponsor another entrepreneur's participation.
Which of the following session times would work best for you? (Select only 1.)*

Mondays, March 13 through April 10th 2023 5:30 pm - 8:00 pm EST (Every Monday for 6 weeks)
Which of the following (if any) describes your previous entrepreneur leadership training? (Select all that apply.)*

College/UniversityOnline TrainingJULO Strategy WorkshopsCEO Mindset Phase OneCEO Mindset PhaseTwoCO.STARTERS (Get Started Workshop)Action ZoneThriveBunker LabsEmpowHERment Entrepreneuer Academy
Other Training-Please write in
What do you expect to gain from participation in CEO Mindset? *
Terms of Participation
Upload a recent headshot*
As a part of the JULO Strategy community, I understand that it is my responsibility to uphold the following principals: • Place: We value the place around us. • Collaboration: Our community values creative cooperation and collaboration. • Respect: JULO Strategy is a respectful place. It is safe for diversity, ideas, inspiration, and creativity. • Value: Our community honors hopes, dreams, and values. • Inclusion: All are invited to join and build on the conversation. • Energy: JULO Strategy is a place where creative energy can thrive. • Mutual Benefit: A rising tide lifts all boats. I understand that JULO Strategy does not and can not guarantee that I will be successful in my business. Furthermore, the benefits gained from participating in JULO Strategy’s programs are a result of time, energy and dedication from the founder(s), and thus are not based solely on the completion of the programs. I further understand and authorize JULO Strategy to provide applicable information to the assigned mentors and facilitators. I understand that any information released to be held in strict confidence by him/her. JULO Strategy has the right to accept or deny applications for any reason. No person will be excluded from participation in or otherwise subjected to discrimination in regard to services, programs and employment provided by JULO Strategy based on race, sex, color, national origin, sexual orientation, disability, age or religion.*

Yes, I agree to the aboveTerms of Participation
I understand that once I'm accepted as a participant of CEO Mindset Phase 1, I will be invoiced for the program fee, less any promotional discounts or grants, in which case I will be invoiced the appropriate fee. This fee must be paid before the start of class.*

Yes, I agree to the above Terms of Participation
I understand that the facilitators of JULO Strategy rely upon the active participation and assistance of local volunteers in order to effectively operate the program. These volunteers include, but are not limited to, mentors and speakers. I further understand that JULO Strategy is most effective when participants are willing to freely share experiences and advice with one another during the course of the program. In order to encourage these vital contributions, as well as those of program staff and facilitators, I hereby release, discharge, and hold harmless JULO Strategy, program staff, facilitators, volunteers, and fellow participants from any and all claims, demands, or causes of action that I may hereafter have based upon the advice provided during the program and I understand that I am entirely responsible for the results of the decisions I make involving my venture during and as the result of my participation in JULO Strategy.*

Yes, I agree to the above Terms of Participation
Each six-week class participant receives a one-on-one Strategy Session with Juliann Nichols. Juliann loves the one-on-one interaction with you and carves out specific times in her schedule to have those moments with you. We understand that your time is valuable, as well, and things do happen, so we have a Late/Rescheduling/Cancellation Policy for the one-on-one meetings with Juliann. We ask that you kindly provide at least 24-hours to reschedule or cancel your one-on-one time with Juliann. This will afford her the opportunity to book that time with another client. If that is not possible, or if rescheduling happens frequently, it is at the discretion of JULO Strategy management to charge the client a cancellation fee of $200. This is 50% off her regular hourly rate of $400. Please understand the value Juliann provides to you and respect her time. Communication is key. Please let us know that you will be arriving late. Should you arrive late to your one-on-one, Juliann will wait ten minutes and if you do not show for your appointment, you will forfeit the opportunity to have that one-on-one with her.

Yes, I agree to the above Terms of Participation
I do hereby give permission to JULO Strategy, its agents, and others working under its authority, full and free use of video/photographs containing my image/likeness. I understand these images may be used for promotional, news, research, and/or educational purposes. I do further certify that I am either of legal age, or possess full legal capacity to execute the foregoing authorization and release.*

Yes, I agree to the above Terms of Participation
e-Signature*

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PHASE One-CEO Mindset™ Application

Getting Started

Tell us more about you so we can best understand your background

Thanks for the information about you. Now, tell us more about your Company

Commitment

Terms of Participation