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Black Founders Hub Application
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* Indicates required question
Email
*
Your email
Background
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
Your answer
Date of Birth (If you are 18 years or under, please have your parent or legal guardian contact us to complete your registration. Your registration is important to us, and we look forward to welcoming you into our community!)
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MM
/
DD
/
YYYY
City
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Your answer
Province
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Your answer
How would you describe the area in which you live?
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Urban
Suburban
Rural
Where I work
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Working in my business full time
Working in my business full time and full or part time somewhere else
Working in my business part time
Student
Retired
Other:
Education
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High school
Vocational school
College
University
Graduate school
Gender
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Female
Male
Prefer not to answer
Other:
The racial and ethnic group that I identify with is (please select all that apply)
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Black (e.g. African Canadian, Caribbean, North American, Black British)
East Asian (e.g. Chinese, Japanese, Korean)
Hispanic or Latinx
Indigenous (e.g. First Nations, Metis, Inuit, Native American, Aboriginal or Torres Strait Islander, Maori)
South Asian (e.g. Bangladeshi, Bhutanese, Indian, Nepali, Pakistani, Sri Lankan)
Southeast Asian (e.g. Cambodian, Filipino, Indonesian, Laotian, Malaysian, Singaporean, Thai, Vietnamese)
Native Hawaiian or other Pacific islander
North African or Middle Eastern
White (e.g. European, North America, Pakeha)
A racial or ethnic group not listed
Prefer not to answer
Required
Do you identify as a person with a disability?
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Yes
No
Prefer not to answer
Do you identify as 2SLGBTQI+? (The LGBTQI+ acronym refers to Two-Spirited, Lesbian, Gay, Bisexual, Trans, Queer, Questioning, Intersex, Plus other Sexual and Gender Minorities)
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Yes
No
Prefer not to answer
I have lived in Canada for
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Less than 5 years
More than 5 years
Prefer not to answer
Your Business
Business name
*
Your answer
Your title
*
Your answer
Business website (Please write "NA" if not applicable)
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Your answer
Social media platforms your business is active on
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Instagram
Facebook
LinkedIn
(Not applicable)
Other:
Required
Date founded
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MM
/
DD
/
YYYY
Which industry does your business most closely align with? (Choose up to 2)
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Retail & Consumer Products
Education
Health & Science
Food & Beverage
Hospitality & Tourism
Marketing & Communications
Professional Services
Finance & Insurance
Manufacturing
Technology
Fitness & Recreation
Arts & Entertainment
Agriculture & Forestry
Other:
Required
Which best describe your business (regardless of whether your business is online or brick-and-mortar)?
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Product
Service
SaaS (Software as a Service)
Other:
Required
Briefly describe your business
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Your answer
Which Sustainable Development Goals align most with your business? (check all that apply)
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No Poverty
Zero Hunger
Good Health and Well-being
Quality Education
Gender Equality
Clean Water and Sanitation
Affordable and Clean Energy
Decent Work and Economic Growth
Industry, Innovation and Infrastructure
Reduced Inequality
Sustainable Cities and Communities
Responsible Consumption and Production
Climate Action
Life Below Water
Life on Land
Peace and Justice Strong Institutions
Partnerships to achieve the Goal
Other:
Required
What percentage of the business do you own?
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Your answer
Years of previous business experience
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Your answer
Number of employees at your business
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Your answer
My business is
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Not registered
Incorporated
Registered sole proprietorship
Registered partnership
Business stage
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Pre-startup
Pre-revenue
Early growth
High growth
What are you currently seeking assistance with in your business?
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Your answer
Do you have a business plan?
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Yes
No
Work in progress
Do you have up-to-date financial statements for your company?
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Yes
No
Work in progress
What are your projected revenues/sales in the 2022 fiscal year?
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Your answer
Do you pay yourself?
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Yes
Yes, at market value
No
Do you currently export your products outside of your province or Canada?
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Yes
No
If yes, where do you export?
Your answer
Please share your strategic goals or priorities for the next 12 months.
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Your answer
Additional Information (optional)
Your answer
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