Application for FOUNDER ENTRY: Apply With Existing Business or Concept

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If you are applying with co-founders, only one form needs to be completed per group - you do not need to complete one form each.

Need a reminder about the application deadline? Follow us on Twitter (https://twitter.com/BaseImpact) or Facebook (https://www.facebook.com/ImpactBaseIncubator) to get reminders.

TIP: the best answers are those that (1) do not use jargon, (2) actually answer the question, and (3) are detailed, this is not a competition to see how few words you write - make sure you explain your answers to us. Good luck!

What is your full name? (first name, last name) *

What is your email address? *

What is your phone number? (sample: 07911 123456) *

What city do you live in? *

What is your sex? This is an optional question and the responses will not influence selection. You may skip it if you prefer not to respond.

Female

Male

Prefer not to say

Other:

Clear selection

What is your age in years? This is an optional question. You may skip it if you prefer not to respond.

Are you applying with co-founders? *

Yes

If yes, what are their names?

If yes, what cities do they live in?

If yes, what are each of their email addresses and contact phone numbers?

If applicable, how long have you known your co-founders?

What are the top three critical characteristics that you (and your co-founders, if applicable) possess to build a successful business? *

What is your business name? *

If you have one, what is your business website? *

At what stage is your business? *

Already generating revenue

Operating but not yet generating revenue

Started building it, but not yet operational

It's still a concept

Other:

How long have you been working on your business? *

Is anyone working full time on the business? If so, who and for how long have they been full time? *

How far has the business progressed and what are the major challenges you are encountering (name up to 3)? *

If your business is already generating revenue, how much did it generate in 2019? *

How many customers do you have? *

What problem does your business or concept solve? *

Describe in one or two sentences how it solves that problem *

What do you understand about your industry that other companies in it do not? *

In the next 12 months, what will your business achieve? How would you hope that would change if you were accepted by ImpactBase? *

Why do you believe your business can scale nationally or globally? *

What do you most want from the ImpactBase Pre-Seed Program? *

Do you or any of your team belong to any of the following groups (check all that apply): *

Individuals from a diverse racial and ethnic group that is underrepresented in entrepreneurship in the UK.

Individuals with physical or mental impairment that substantially limits one or more major life activities.

Individuals who come from a family with annual income below established low-income thresholds in the UK

Individuals who will be the first child in their family to graduate from a university or college

Other disadvantaged group

If you belong to any of the above groups or another disadvantaged group that is not covered above, please explain your particular situation.

Are you and any co-founders available to attend ImpactBase every weekday except public holidays between April 6th and 17th 2020? *

Yes

Maybe / not sure

Is there anything else we should know or take into account? *

How did you hear about us? *

Confirm you [and all of your co-founders if their details are listed above] agree to our privacy policy *

Agree

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