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Home » Ventures » 2013 Ventures program - Apply

Application Form

Name of Company/Project: *

First Name: *

Last Name: *

Phone Number: *

E-mail: *

Street Address: *

City: *

State:

Country: *

Company URL (if you have one):

Please identify the sector that most closely identifies with your company. If none of the options is applicable, select "other": *

Clean Technology/Environmental

Education

Community Building

Social Finance

Public Health

Other

If "other" please explain:

In 50 words or less, what significant unmet social need is your company addressing?: *

What innovative product, service, or business model are you developing to address this need?: *

How can your social objectives be sustained in a for-profit model?: *

Describe your business model. Who are your customers? Why will they pay?: *

How will you reach your customers?: *

How long have you been working on this company?:

How far along are you in planning your business? (If you have a business plan you will be able to attach it at the end of this application): *

Idea: *

Prototype: *

Beta: *

Commercial Product: *

Do you have a company?: *

Yes

No

If yes, is it a corporation or a limited liability company? :

Corporation

Limited Liability Company

Other

How much cash (not sweat equity) have you and/or others invested in this idea so far?: *

If you have received funding other than from owners and family members, (i.e. angel investors, government agencies), list your three largest investors and their percentage ownership: *

How much money do you need to get your business to the next step? Where do you anticipate raising the funds? How do you anticipate raising the funds? How do you anticipate using it? If available, please attach a budget for the next 12 months: *

Full Name: *

What is your current role in developing the business and what do you expect your role to be going forward?: *

What percentage of your time are you currently spending on this project, and how much do you anticipate spending over the next couple of years?: *

What is the source of your passion and domain expertise?: *

Resume of Primary Contact (MS Word or PDF): *

Resume of Second Team Member (MS Word or PDF) :

Resume of Third Team Member (MS Word or PDF) :

Resume of Fourth Team Member (MS Word or PDF):

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GoodCompany Ventures

Building a commercial strategy to implement and scale each entrepreneur's vision for social innovation.

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Providing physical space and professional support to entrepreneurs in the Philadelphia area.

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Helping our entrepreneurs accelerate their business ideas from concept to company.

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