IGNITE Rural Application Form - Envision Greater Fond du Lac

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Contact Details

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone

Address

Street Address Address Line 2 City State ZIP Code

Preferred day(s) for classes

Monday

Tuesday

Wednesday

Thursday

Friday

Preferred time of day for classes

Business idea description(Required)

LinkedIn Profile

Business Information

Business Name(Required)

Business Website (if applicable)

Business Address

Street Address Address Line 2 City State ZIP Code

Industry/Category(Required)

Years in Operation(Required)

Brief description of the business(Required)

Current stage of the business (e.g., idea, startup, established)

Number of employees (if any)

Annual revenue (optional)

Description of product(s) or service(s)(Required)

Target market/customer base(Required)

Unique value proposition(Required)

Program Interest

Why are you interested in the IGNITE Rural program?(Required)

What are your business goals for the next 6-12 months?(Required)

What do you hope to gain from participating in this program?(Required)

Describe any current challenges or obstacles your business is facing.(Required)

Program

Are you able to attend all sessions from September 5 to November 7?(Required)

Yes

No

Any potential scheduling conflicts?

Yes

No

If yes, what is the potential conflict?

References (contact information for 1-2 business references)

Any additional information you would like to share about your business or yourself?

Signaure (type full name)

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