Full Name *

Business Organization Name *

Your Role *

Business Email Address *

Business Phone *

City and State Where You Operate *

What date did you start your business? *

Industry/Niche *

Which of the following do you currently have in place for your business or organization? (Select all that apply.) *

Is your business or organization woman-owned or woman-led? *

Is your business or organization minority-owned or minority-led? *

Is your business or organization veteran-owned or veteran-led? *

What is your current annual revenue range? *

About how many people have you served, helped, trained, coached, taught, or impacted so far? *

Do you have a logo? If yes, please attach below

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Do you have a website? *

If yes, share your link.

Do you use social media for your business? Example: Facebook, Instagram, TikTok. *

Please share your main business social media or where you promote the most.

Do you have a registered trademark? *

Who is your target audience? Example: Children, parents, small business owners, churches, and communities *

In your own words, tell us what you do and how your work helps the people or community you serve. *

What makes your work special or different? *

What change do you want to see because of your work? *

What problem do you solve? *

What inspired you to start your business? *

Why does your work matter? *

Without the funding, who suffers? *

What services, programs, or products do you currently offer? *

What is your main focus? Example: Education, coaching, wellness, creative work, community outreach *

How do you deliver your services? *

What positive results have you seen so far? Example: Testimonials, client progress, engagement, growth *

Have you ever applied for a grant before? Yes / No *

Have you ever received a grant? *

If you received $25,000 in FREE funding, what exactly would you use the money for? *

About how much funding would make a real difference for you right now? *

$

Within the next 12 months, if all things were exactly as you envisioned, tell me a story of what it looks like. *

What feels most challenging for you right now? *

Is there anything that we haven't ask that would make a difference in your funding story?