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Adopt A Startup - Application Form
We kindly ask you to fill in the form below in order to assess the potential fit for the program and, if selected for the program, to be matched to the right mentors. Thanks in advance!
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Email
*
Your email
Point of Contact - Name
*
Your answer
Point of Contact - Role
*
Your answer
Point of Contact - Phone
*
Your answer
STARTUP DETAILS
Name of Startup
*
Your answer
Website
*
Your answer
Year founded
*
Your answer
Sector (if more apply, please check them)
*
Retail
E-commerce
Luxury
Fashion
Tourism/Travel
Finance/Insurance
Healthcare
BioTech/CleanTech
Government
CPG
Food
Electronics
Media
Telecommunications
Other:
Required
County where you're based
*
Your answer
Is there a senior level representative from your Startup willing to commit his/her time to the program?
*
The program is 12 weeks in duration and requires significant time investment
Yes
No
Please briefly describe your company's mission and value proposition.
*
Your answer
What is new about your product/service relative to the market/industry?
*
Your answer
How would you best describe your progress status?
Development
Public/Private Beta
Launched, no Customers, no Revenue
Launched, Customers, no Revenue
Launched, Customers and Revenue present
Scaling up customer acquisition, Customers and Revenue present
Expansion and Business Development Growth
Clear selection
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