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Thank you for your interest in Social Enterprise Greenhouse. Please take a moment to complete this form. The first page is general information and the second contains specific information needed for the service for which you are requesting.

Please message info@segreenhouse.org, if you have any questions.

First Name, Last Name *
Your answer
Position Title *
If not applicable, please answer N/A
Your answer
Home Address
Street *
Your answer
City/Town *
Your answer
State *
Zip Code *
Your answer
Telephone *
Your answer
Email *
Your answer
Venture Address
Street
Your answer
City
Your answer
State
Zip Code
Your answer
Telephone
Your answer
Email
Your answer
Basic Venture Information
Name of Venture *
If the venture does not currently have a name please answer N/A
Your answer
Where does/will your venture operate? *
Country, Region, and/or City (Where is the primary locale of sales, clients, and beneficiaries of your venture)
Your answer
What is your industry? *
Please pick the industry that best fits your primary activity
Does your Venture fall into one of the industry clusters below? *
Required
Venture established in *
Please respond when you began actively working on your venture
MM
/
DD
/
YYYY
Number of Employees (Part-time, Full-time) *
ex. 10 (Part--Time), 6 (Full-time)
Your answer
Legal Structure *
Required
Which best describes your venture? *
Does your business fit any of the following features? *
Please check all that apply any individual in you leadership team (i.e CEO, co-founder, CFO, Partner)
Required
With which ethnic/racial group(s) do you most identify? *
Check all that apply.
Required
Annual Operating Budget *
Venture Stage *
Federal Tax ID (if incorporated)
Your answer
Mission *
Mission is a statement about why your venture exists
Your answer
What does your venture do? *
Elaborate on what you are doing, how you are doing it, and for whom you are doing it for
Your answer
How is your venture a social enterprise? *
Your answer
Where is your geographic area of impact? *
If you are not yet operational please answer your planned geographic area of impact
Required
Beneficiaries of your venture's work *
Please only select the primary groups which your venture specifically serves
Required
How did you hear about SEG? *
Have you been in contact with someone from SEG, prior to filling out this form? *
If yes, with whom?
Your answer
In which of the following areas could your venture use support? *
Required
Which program are you submitting an application for? *
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