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SWNM | Registration | CO.STARTERS
Thank you for your interest in CO.STARTERS! We're excited to work with you on your entrepreneurship journey.
Please complete the following form to register for a Spring 2021 Cohort.
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* Indicates required question
Email
*
Your email
Which Cohort are you registering for? If you are registering for the Grant County Cohort, please visit
www.swnmact.org
*
Catron County
Hidalgo County
Luna County
First Name:
*
Your answer
Last Name:
*
Your answer
What is your phone number?
Your answer
What is your mailing address?
*
Your answer
Business Name
*
If you haven't decided on a name yet, type "Still working on it."
Your answer
Business Website: if applicable
Your answer
Tell us a little about your venture.
*
What will it be? Who will be your customer? What are you selling?
Your answer
Which best describes the stage of your venture?
*
Concept Stage: I have an idea that I'd like to move forward.
Startup Stage: I am in the beginning of starting my venture and am trying different things, but I've still got some work to do to make sure the model is sustainable.
Operating Stage: My venture is up and running and I am trying to build on that.
Have you launched a different venture in the past?
*
Yes
No
What are you hoping to get out of this program?
*
Help with marketing? Raising capital? Peers to bounce ideas off of? Accountability? These and more are all great answers!
Your answer
Which of the following best describes how you plan on working within your venture?
*
It will be my full-time job (35 hours or more per week)
It will be my part-time job (less than 35 hours per week)
It will be my "side-gig" to add extra income
It will be my passion project and my primary goal is not to make money from it
I don't know yet
Other
How did you hear about this program?
*
Your answer
What gender do you consider yourself?
*
Female
Male
Gender Non-Conforming(GNC)
Prefer not to say
What best describes you? (select all that apply)
*
Aboriginal or Torres Strait Islander
American Indian or Alaskan Native
Asian
Black
Hispanic, Latino, or Spanish Origin
Maori
Middle Eastern of North African
Native Hawaiian or Pacific Islander
White/Caucasian
Other race, ethnicity or origin
Prefer not to answer
Required
Have you served in the military?
*
Yes
No
Prefer not to answer
Do you have any physical, visual, auditory or cognitive impairments that you would like us to be aware of? Please list below.
Your answer
Which of the following describes your age group?
*
18 - 25
26-35
36-45
46-55
56-65
66-75
75-85 +
Prefer not to answer
Which of the following best describes your current employment or educational status? (select all that apply)
*
Employed Full-Time
Employed Part-Time
Self-Employed Full-Time
Self-Employed Part-Time
Unemployed
Retired
Student
Other
Prefer not to answer
Required
What best describes the highest level of education you have completed?
*
Some high school
High school diploma or GED
Some college/university
Associate's degree
Bachelor's degree
Master's degree
Professional degree (e.g. MD, JD, etc.)
Doctorate degree (e.g. PhD, EdD, etc.)
Currently enrolled in college/university
Other
Prefer not to answer
Which of the following best describes your annual household income?
*
$5,000 - $10,000
$10,000 - $25,000
$25,000 - $50, 000
$50, 000 - $100,000
$100,000 - $125,000 +
Prefer not to answer
How many people live in your household?
*
Choose
1
2
3
4
5
6
7+
Which of the following best describes what your venture will provide its customers?
*
Product(s)
Service(s)
Both Product(s) and Service(s)
I'm not sure yet.
Which of the following industries does your venture fall within?
*
Choose
Cause
Consumer Services
Creative/Arts/Culture/Craft
Education
Entertainment
Event Spaces and Studios
Food, Restaurant, and Beverage
Health and Wellness
Outdoor/Environment/Sustainability
Professional Service (e/g/ Finance, Insurance, Legal)
Products, Retail, and Shopping
Technology
Video, Film, and Photography
Other
Which geographic area do you anticipate your venture primarily serving? (select all that apply)
*
My Local Community
My State/Province
Region (More than one state or province)
National Market
International Markets
I am unsure
Other
Required
Are you starting this venture alone, or do you have one or more co-founders?
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On my own
I have one co-founder
I have multiple co-founders
I'm not sure yet
Other
Thank you!
Thank you for completing the Grant County CO.STARTERS registration, we will be in touch soon via email. Please add
emily@swnmcog.org
to your contacts.
Send me a copy of my responses.
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