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Startup Check-In

Full name

*

Email Address

*

location

*

Start up name

*

Start up name

*

Industry of your startup

*

LinkedIn profile

*

Stage of your start up

*

Stage of your start up

A

Pre-seed

B

seed

C

series A

D

Growth

E

Late

F

other

*

Are you currently seeking funding?

*

Are you currently seeking funding?

A

No

B

Yes, immediately

C

Yes, 3-6 months

D

Yes, 6-9 months

E

Yes, 9-12 months

Are you interested in crowdfunding as a means to raise funds?

*

Are you interested in crowdfunding as a means to raise funds?

A

No

B

Yes

C

Maybe/Need more information about crowdfunding

What are the biggest challenges you are currently facing with your startup?

*

Are you generating revenue?

*

Are you generating revenue?

A

Yes

B

No

C

Will generate revenue in the next 3 months

what type of support are you actively seeking?(select All that apply)

*

what type of support are you actively seeking?(select All that apply)

Access to Capital

Finding A Co-Founder

Building A Team

Hiring

GO to market strategy

Customer Discovery

Legal

Pitch Deck

Business plan

Financials

other

*

short term Goals(6 -12 month)

*

Do you currently have customers?

*

Do you currently have customers?

A

Yes

B

No

C

Unsure

Are you part of an accelerator Program?

*

Are you part of an accelerator Program?

A

Yes

B

No

if yes, What is the name?

*

Are you interested in an accelerator program?

*

Are you interested in an accelerator program?

A

Yes

B

No

C

Unsure

*

Are you open to collaboration opportunities with other startups or founders?

*

Are you open to collaboration opportunities with other startups or founders?

A

Yes

B

No

C

Unsure

May contact you for the follow - up discussion or to provide tailored support?

*

May contact you for the follow - up discussion or to provide tailored support?

A

Yes

B

No