Alkhemy Incubator/Accelerator Application

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Last Name *

First Name *

Phone Number *

Zip Code *

Gender *

Race *

Household Income (Annual) *

$0 - $15,000

$15,001 - $30,000

$30,001 - $50,000

$50,001 - $75,000

$75,001 - $100,000

Over $100,001

Age *

17 or younger

18-20

21-29

30-39

40-49

50-59

60 or older

Name of Organization *

Is this your first enterprise or organization? *

Yes

Website or Social Handle *

Location of Business (Zipcode)

Tell us about your socail enterprise or organization? Or idea for a social enterprise? *

What stage of growth is your social enterprise or organization in? *

Exploration (Don't have a clear business idea yet)

Getting Started (Have an idea but haven't started yet)

Start Up (Have been running the business formally or informally, but not yet taken off)

Growth (Have been running the business for a number of years and trying to take it to the next level)

How did you hear about the Alkhemy Seed Incubator? *

Word of Mouth

Social Media

Other:

What are your current constraints to growth? *

Do you feel like you have the social, cultural, intellectual, financial capital that you need to be successful ? *

Yes

Other:

How did you become interested in being an entrepreneur? Does it run in your family? Did you have a specific experience that impacted your path to entrepreneurship? *

If you are successful, Indianapolis will be better off because… *

How many people do you plan to employ in the future? *

How many people do you employ now ? *

Tell us what you see as your top 3 challenges. *

Tell us what you see as your top 3 strengths. *

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This form was created inside of Kheprw Institute.