Intake Form: Entrepreneurship & Business at ConnexionWorks
Welcome! Thank you for expressing interest in entrepreneurship & business at ConnexionWorks!

Please fill out this form below to tell us more about you, your interests, and business experience. Next, we will contact you to set up a discovery session so our ConnexionWorks team can see how we can help you on your journey.

For any immediate questions, please connect with kayla.johnson@connexionworks.ca.
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Please tell us about you!
What is your first name? *
What is your last name? *
What pronouns do you use? *
Please share your email address. *
Please share your phone number. *
What is your mailing address? *
City *
Province *
Postal Code *
What is your country of origin?
Do you identify with any of the following? Check all that applies. (This information is helpful to our team as there are lots of additional support for individuals of the following groups) *
Required
Why are you connecting with ConnexionWorks? Check all that apply.   *
Required
Are you applying for a specific program? Please check which applies. *
Required
How did you hear about us? Please check all that apply. *
Required
Do you want to be added to the mailing list for monthly newsletters and updates? *
Tell us more about your VISION!
What’s your purpose / your why?   *
Where would you like to see yourself in 5 years? *
About Your Business or Idea
Please share as much or as little as you like. This will help us understand the basic information about your business or business idea. This information will remain confidential within the ConnexionWorks leadership team.  
Where are you on the entrepreneurial journey? *
What is the name of your business/idea?  
How is your business currently registered?  
Clear selection
What Industry best represents your business/idea?
What product or service do/will you offer? Please explain.
Please share any links to your business/idea.
Do you have any business partners in your venture? Please name them if so.
Are you currently working full-time or part-time on this business/idea?  
Clear selection
What are your short-term goals with this business?
What are your long-term goals with this business?  
What are your biggest challenges right now? Check all that apply.  
Please share any other challenges you are currently facing.  
How can the ConnexionWorks team help you (programs, mentorship, connections, funding navigation, etc.)?  
Please add any other comments you may have.
Thank you!!
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