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.
Getting Started
Were you referred to us? Tell us how and/or who?
How were you referred to JULO? *

Veterans Florida FAVOB (Florida Association Veteran Owned Businesses) Action Zone Individual Facebook LinkedIn JULO Strategy
Name:

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

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

Month Day Year
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.

Browse Files

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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

City State / Province

Postal / Zip Code
Tell us more about you
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? *
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? *
About Your Company
Company *
Position *
Company Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Company Phone Number *

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)? *
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? *
Are you an Attorney? *

Yes No
What area of law do you specialize? (for non-attorneys reply "NA") *
What is the size of your Law Firm? *

Solo (just me) Small Firm 2-10 Medium Firm 11-20 Larger Firm 20+ NA
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? *

Yes No Plan to in the next 6 months Plan 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 ME 1 additional 2 3 4 5-10 11-15 16-20 21-30 31-40 50+
What goals do you hope to accomplish during your time in CEO Mindset?
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 *
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 (select all that apply to you): *

I am able to pay now and secure my seat in the cohort I would like information about available scholarships or payment plans I would like to know how I can sponsor another entrepreneur's participation. I am a Veteran and would like to know more about the Veterans Florida program
Which of the following session times would work best for you? (Select only 1.) *

Wednesdays Nov 4th through Dec 9th, 2020 5:30 pm-8:30 pm Wednesdays Jan 6th through Feb 10th, 2021 5:30 pm - 8:30 pm
Which of the following (if any) describes your previous training? (Select all that apply.) *

College/University Online Training JULO Strategy Workshops CEO Mindset Phase One CEO Mindset PhaseTwo CO.STARTERS (Get Started Workshop) Action Zone Thrive Bunker Labs
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 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
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

About Your Company

Commitment

Terms of Participation