A Program of the Institute for Entrepreneurial Leadership
Signature Angel Investing Program Application
Spring 2024
1. Name
*
First Name
Last Name
2. Pronouns
*
3. Employer
*
4. Job Title
*
5. Gender
*
6. Race/Ethnicity (Select all that apply)
*
African-American/African/Caribbean/Black
Asian/Asian-Indian
Hawaiian/Pacific Islander
Hispanic/Latinx
Indigenous
Middle Eastern/North African (MENA)
White
Prefer not to say
Other
7. Email
*
example@example.com
8. Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
9. LinkedIn Profile
10. How did you learn about Pipeline Angels?
Please Select
Search Engine (Google, Bing, etc.)
Recommended by a friend or colleague
Email
Social Media
Blog or publication
Other
Who recommended you?
*
Kindly specify.
11. Are you an accredited investor (i.e., US$200K in income or US$300K joint income with spouse for the past two years, or US$1M net worth, or holding in good standing one or more of the following FINRA certifications/designations: Series 7, Series 65, Series 82)?
Yes
No
I'm not sure
12. In which city are you based?
*
13. In which state?
*
14. In which country?
*
15. Can you commit to pay the US$4,500 program fee?
*
Yes
No
16. Can you commit US$5,000 to invest in a company via the Pipeline Angels pitch summit process?
*
Yes
No
17. Are you applying with a friend?
*
Yes
No
What is their name?
*
18. Have you ever invested in a for-profit startup?
Yes
No
19. Any Angel investment carries the risk of losing the entire investment amount. Are you comfortable with that risk?
*
Yes
No
20. What excites you about Pipeline Angels?
*
21. What do you hope to learn or gain through Pipeline Angels?
*
22. How will your membership in Pipeline Angels contribute to our vision of a more inclusive entrepreneurial ecosystem?
*
23. As you know, it takes money to run a business--especially a mission-based one! Please share more details on why you're currently not able to commit to paying the US$4,500 program fee:
*
While I do have the funds to pay for this program in full, I need to learn more before committing to pay.
While I would be able to pay for the program in full, I would need to pay over a period time via a payment plan. (I also would like to learn more!)
At this time, even with a payment plan, I’m not able to pay for the program in full. With financial support from Pipeline Angels, I may be able to partially fund my participation. (I also would like to learn more!)
At this time, even with a payment plan and partial financial support from Pipeline Angels, I would not be able to contribute financially to my participation in the program.
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