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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
To 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 applying for?
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