Home
About Us
Contact Us
About The Network
Who We Are
FAQ
Contact Us
Resources
Investment
Akron BioInvestments Funds
Alliance Startup Fund
Appleseed Microfinance
The ARCHAngel Network
Barberton Growth Fund
Canton Entrepreneur Launch
Concept Capital
Emerging Market Fund
Glengary
Innovation Fund of Lorain County Community College Foundation
JumpStart
North Coast Angel Fund
Cuyahoga County North Coast Opportunities Fund
Tech Sprout
Wooster Opportunity Loan Fund
Business Assistance
Akron Global Business Accelerator
Austen BioInnovation Institute in Akron
BioEnterprise
BioHio Research Park
Bizdom
Braintree Business Development Center
Goldman Sachs 10,000 Small Businesses
Great Lakes Innovation and Development Enterprise (GLIDE)
Higher Education Collaboration Council
The Incubator at MAGNET
JumpStart
LaunchHouse
Northeast Ohio Medical University (NEOMED)
NorTech
Ohio Aerospace Institute
Ohio Agricultural Research and Development Center (OARDC)
The Tech Belt Energy Innovation Center (TBEIC)
University of Akron Research Foundation
Youngstown Business Incubator
Toolkit
Newsletters
Jobs
Apply
Events
News
Client Company News
Resource Provider News
Home
>
Apply
>
Application Form
Application Form
About You
All fields marked with an asterisk
*
are mandatory.
Title:
*
(select Title)
Mr.
Mrs.
Ms.
Miss
Dr.
Other
First Name:
*
Last Name:
*
Company Name:
*
Job Title:
*
Address:
*
City:
*
State/Province
*
[Select]
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
*
Phone Number:
*
(Please use the format xxx-xxx-xxxx)
Cell Phone Number:
(Please use the format xxx-xxx-xxxx)
County:
*
(select County)
Ashland
Ashtabula
Carroll
Crawford
Columbiana
Cuyahoga
Erie
Geauga
Holmes
Huron
Lake
Lorain
Mahoning
Medina
Portage
Richland
Stark
Summit
Trumbull
Tuscarawas
Wayne
Other Ohio County
Outside of Ohio
Email Address:
*
Website:
How did you hear about us?
(select one)
Email Newsletter
Event
Online
Print newspaper/magazine
TV
Radio
Personal Referral
Please specify:
I was asked to fill out this form by a person at:
(select one)
Akron Community Service Center and Urban League
Akron Global Business Accelerator
Akron Minority Business Development Organization
BioEnterprise
Braintree Center for Business Innovation
Glengary, LLC
GLIDE (Great Lakes Innovation and Development Enterprise)
Innovation Fund at Lorain County Community College
JumpStart Higher Education Collaboration Council
JumpStart Inclusion Advisors
JumpStart Ventures
Kent PTAC-Kent Regional Business Alliance-Kent State University
MAGNET (The Manufacturing Advocacy and Growth Network)
MTSBDC at Kent State University
NEO PTAC-Lake County Port Authority
NEOTEC ITAC Kent state University
NorTech
North Coast Angel Fund
North Coast Opportunities Technology Fund of Cuyahoga County
Ohio Aerospace Institute
Ohio ITAC
Ohio SBDC at Kent Regional Business Alliance
Ohio SBDC at Kent State University Stark Campus
Ohio SBDC at Kent State University Tuscarawas Campus
Ohio SBDC at Lake County Port Authority
Ohio SBDC at Lorain County Chamber of Commerce
Ohio SBDC at Summit Medina Business Alliance
Ohio SBDC at Youngstown State University
Ohio SBDC/MBDC at the Urban League of Greater Cleveland
SWCO PTAC at Columbus
Tech Belt Energy Innovation Center
Urban League of Greater Cleveland-Entrepreneurship Center
Urban League of Greater Cleveland-MBAC
Wooster Opportunities Fund
Youngstown Business Incubator
Nobody
Other*
Other:
About Your Business Idea
Industry Categorization:
*
(Select One)
Advanced Materials
Aerospace & Defense
Agriculture
Automotive & Transport
Banking
BioSciences
Business Products & Services
Chemicals
Construction
Consumer Products & Services
Education
Electronics
Energy/Power/Propulsion
Environmental Services & Equip.
Financial Services
Food & Beverages
Healthcare
Industrial Manufacturing
Information Technology/Internet
Insurance
Leisure
Media & Entertainment
Medical
Metals & Mining
Pharmaceuticals
Real Estate
Retail
Security Products & Services
Telecommunications
Transport Services
Other
Provide a brief summary of your company/product/idea. Please indicate what is unique: (100 words or less)
*
How much cash has been invested in the business to-date?
*
Please indicate sources of investment(s): (check all that apply)
Owner/Founder
Grants
Friends and Family
Angels
Venture Capital
Sales Revenue
Loans
None
Other (Please Specify)
How much cash are you seeking at this time?
Are you interested in pursuing a
high-growth
business strategy which may involve raising money from outside sources, including venture capital and other funds?
*
Yes
No
Not Sure
Are you aware that taking outside capital will result in decreased
equity
?
*
Yes
No
N/A
Is your company minority-owned or managed?
*
Yes
No
If yes, please specify Minority Group (see
Federal definitions
):
(please specify)
African American
Native American
Latin-American/Hispanic
Asian-Indian, Asian-Pacific, Pacific Islander American
Is your company woman-owned or managed?
*
Yes
No
Including yourself, how many
full-time
employees work for the company?
*
We only work with businesses located in one of the
21 counties of Northeast Ohio
. By selecting yes, you confirm you are either currently located in Northeast Ohio or will agree to relocate here as needed.
*
Yes
No
JumpStart Inc. is a non-profit economic development agency serving the citizens of Northeast Ohio. If we agree to provide you with business assistance, we will do so at no charge to you. We disclaim (and you waive) all warranties related to the assistance we may provide to you, and you also agree that neither JumpStart Inc., its directors, officers, employees nor agents shall be liable to you for any damages, including, without limitation, loss of profit or business opportunity.
I agree to the above terms
probe