MIDFLORIDA SURGE Business Accelerator Application
To apply for the MIDFLORIDA SURGE program, presented by The Well, please answer the following questions. To complete your application, you will need to submit the questions and agree to pay the application fee. Please direct any questions to the attention of The Well MIDFLORIDA SURGE Program via email: thewell.lakeland@gmail.com.
Email *
Please provide your name. *
Please provide your age group. *
MIDFLORIDA SURGE supports minority entrepreneurs. Please provide your racial identity. *
Required
MIDFLORIDA SURGE supports diversity among entrepreneurs. Are you represented by one of the following. *
Required
Please provide your business name. *
Please provide the number of years you have been in business. *
Within what industry does your business operate? *
What is your business structure? *
Do you have business partners? *
Do you have paid employees (including yourself)? *
Please provide the social media accounts and/or website for your business. If you do not have these, please state why. *
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