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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?
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Action Zone
Bridge Local
FAVOB (Florida Association Veteran Owned Businesses)
Individual
JULO Strategy
LinkedIn
Veterans Florida
Veterati
Women's Business Centre
EmpowHerment
CYBER MONDAY
KS Chamber of Commerce
Name:
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First Name
Last Name
E-mail
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Mobile Number
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Other Number
-
Area Code
Phone Number
Which number do you prefer?
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Mobile
Other
Please Select
What is your gender?
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Male
Female
Other
Please Select
What is your race/ethnicity?
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Aboriginal or Torres Strait Islander
American Indian/Alaskan Native
Asian
Black or African American
Hispanic or Latino
Maori
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
Papua New Guinea
Two or more races
White
Other
Prefer not to answer
Please Select
What is your date of birth (XX/XX/XXXX)?
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Month
-
Day
Year
Date
Have you ever served in the military?
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Yes
No
prefer not to answer
Please Select
Which Branch did you serve?
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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?
Yes
No
Prefer not to answer
How did you hear about JULO Strategy?
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Facebook
Instagram
Twitter
JULO Website
Word of Mouth
CO.Starters
Veterans Florida
KS Chamber of Commerce
Google
Other
Home Mailing Address
Street Address
Street Address Line 2
City
State / 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 Time
Employed Part Time
Retired
Self Employed Full Time
Self Employed Part Time
Student
Unemployed
Prefer to not answer
Which best describes the highest level of education you have completed?
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Some High School
High School diploma or GED
Some College/university
Associates Degree
Bachelors Degree
Masters Degree
Professional Degree (e.g. MD or JD)
Doctorate Degree (e.g. PhD, EdD)
Prefer not to Answer
Which of the following best describes your annual household income?
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$25,000 or less
$25,000 - $50,000
$50,000-$75,000
$75,000-$100,000
$100,000 or more
Prefer not to answer
How many people live in your household?
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What is your work and or entrepreneur background and experience?
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Thanks for the information about you. Now, tell us more about your Company
Company
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Position
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Company Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
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
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Company Phone Number
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Area Code
Phone 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)?
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What is the current status of your company?
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Idea: Your business is just a thought or idea. You do not have a sales, or a team and you are validating your product or service
Start: Your products or services are in production, the founding team is formed, the problem you are solving is clearly defined and you have first customers
Grow: Products or services are being refined, revenue is being generated in your initial market and you are preparing to add new team members
Sustain: You've secured a place in the market, have loyal customers, and are not looking to grow at this time
Expand: You are entering new markets or distribution channels as you aim to scale your business beyond the initial period of growth in your original market
Decline: Your business has entered a period where you are losing customers.
Exit: You are currently taking steps to part ways with your company.
What is the legal structure of your company?
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Corporation
General Partnership
Joint Venture
Limited Partnership
LLC (Limited Liability Company)
LLP (Limited Liability Partnership)
Municipality
Nonprofit Corporation
Sole Proprietorship (not incorporated)
Trust
NONE
Which of the following best describes the type of venture you anticipate working on in the CEO Mindset program?
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Business: a venture that exists to provide a product or service that people are willing to buy
Cause: a venture that exists to provide sustainable, impactful solutions to social, cultural, or environmental problems
Give a one-paragraph company bio. (How long you've been in business, what services/product you provide, how you got started, etc.)
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What problem does your business solve?
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In what industry would you categorize your Company?
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What do you define as your target market or market segment?
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How much revenue did your company bring in during the last calendar year (number only)?
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What are your current monthly revenues?
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What is (or will be) your primary source of revenue?
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Selling Products
Selling Services
Selling Subscriptions
Selling Ads
Donations
Other
What has been the main source of funding for your business?
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Personal Savings Personal or Business Credit Card Family Personal or Business Loan from Bank/Credit Union Close Friends Business Acquaintances Other Companies Government Grant Angel Investors Venture Capitalists
Are you currently seeking funding for your business?
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Yes
No
Plan to in the next 6 months
Plan to in the next year
How much funding is your company seeking?
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How much capital, seed or personal funding have you or others invested in your business so far?
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How many hours a week do you plan to work on your business?
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1-10 hours
11-20 hours
21-30 hours
31-40 hours
40+ hours
How many employees do you currently have?
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None- JUST ME
1 additional
2
3
4
5-10
11-15
16-20
21-30
31-40
50+
Have you started selling your product or service?
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YES
NO
Has your Business obtained a Business Bank Account?
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YES
NO
Have you applied or have an EIN (Employer Identification Number) from IRS
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YES
APPLIED
NO
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):
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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 each
I 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.)
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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.)
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College/University
Online Training
JULO Strategy Workshops
CEO Mindset Phase One
CEO Mindset PhaseTwo
CO.STARTERS (Get Started Workshop)
Action Zone
Thrive
Bunker Labs
EmpowHERment Entrepreneuer Academy
Other Training-Please write in
What do you expect to gain from participation in CEO Mindset?
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Terms of Participation
Upload a recent headshot
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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.
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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.
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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.
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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.
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Yes, I agree to the above Terms of Participation
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