Entrepreneur Success Fund Application
Thank you for applying for the 2018 Startup Canada Entrepreneur Success Fund in partnership with TruShield Insurance. This application will take 30 - 40 minutes to complete. Should you have any questions whatsoever, please contact rachelle.desorcy@startupcan.ca.

Non-repayable grants are available up to $2,500.

Application Deadline: August 31, 2018 at 11:59pm PT.

If selected, Startup Canada will reach out to you by: September 15, 2018
Entrepreneur Success Fund Recipient Announcement: October 18, 2018

For more information, visit startupcan.ca/entrepreneur-success-fund.

Section 1: Applicant Information
Please complete the following fields to provide information about yourself.
First name *
Your answer
Last name *
Your answer
Title *
Your answer
Email address *
Your answer
Telephone number *
Your answer
In which city do you reside? *
Your answer
Are you part of any of the following groups?
Full mailing address *
Include Street Address, Apt./Suite # (if applicable), City, Postal Code (for mailing the cheque and additional correspondence).
Your answer
Twitter handle
Your answer
Other social media handles and channels
Your answer
Section 2: Company Information
Please complete form below to share more about your company.
Company name *
Your answer
Company website *
Your answer
Is your company based in Canada? *
When did you found your company / organization? *
MM
/
DD
/
YYYY
Is your company incorporated? If yes, when? *
Your answer
How many individuals are currently employed by your company / organization? *
Your answer
Choose which industry best represents your company *
At which stage is your company? *
Required
Company Twitter handle
Your answer
Social media channel links and explanatory videos (for the company) *
Please provide as many links as possible to provide the judges with a full view of your company culture, brand, and mission, including your website.
Your answer
Pitch your solution to accelerate entrepreneur success in 250 words or less *
Note: This summary may be used in press and media.
Your answer
Please link a Powerpoint Presentation. The presentation should provide a more in-depth overview of your tool, technology, training, initiative or solution promote entrepreneur success. *
Note: Link a file via DropBox, Google Drive or another cloud sharing platform that can be accessible and downloadable by all of the judges. Please feel free to include information the solution you have developed and (1) how it has impacted entrepreneurial success to date, and (2) how funding and network access will be used to scale entrepreneurial success.
Your answer
Provide the names, phone numbers, email addresses and biographical information of at least two references we can contact as part of the adjudication process *
Recommendations: Investors, Clients, Mentors, Economic Development professionals, etc.
Your answer
Please provide a link to at least one (more is preferred) high resolution action shots, products/ services, logo of your organization, etc. Picture should be at least 2000 x 2000 px. *
You may use any online storage site (e.g. Flickr, Google Drive, Dropbox, etc.) or email photos to rachelle.desorcy@startupcan.ca. If you need to email the photos, please indicate that via text below (I will send you photos).
Your answer
Section 3: Leveraging the Opportunity
If selected as a fund recipient, how will you use the funds and what impact will this make on your business? *
Your answer
Do you consent to completing a short impact assessment and interviews (online/print/broadcast) to share your story by February 1, 2019? *
Do you agree to provide evidence of your company and the impact of the grant? *
If selected, are you able to attend Startup Canada Day on the Hill on October 18, 2018? *
Recipients will be announced at Startup Canada Day on the Hill.
Do you agree to make yourself available for media interviews? *
Do you agree to have the answers you provide published and used for various promotional needs by Startup Canada and TruShield Insurance? *
Do you agree to allow Startup Canada to contact you about additional funding and support programs to which you qualify? *
Thank you for completing the form. If selected, Startup Canada will contact you by September 15, 2018.
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