Creating Conscious Collisions Founder Application

Creating Conscious Collisions Founder Application
Learn more about the Creating Conscious Collisions Road Show.
Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Company Name*
Company Website (If you do not have one, pls enter "n/a")*
Business Stage*
Industry Sector*
Number of Employees (including founders)*
Which Road Show cities interest you? (Check all that apply)*

AtlantaBostonCharlotteChicagoDallasDetroitHoustonLos AngelesMiamiPalo AltoPhiladelphiaPhoenixRaleighSeattle
How did you learn about the Creating Conscious Collisions tour events?*

Referred by friend/colleague/organizationIFEL Newsletter/Team MemberIFEL Team MemberSocial MediaBlog or publicationOther
Which person or organization referred you?
Which IFEL Team Member referred you?
What are your company's trailing twelve months sales? [US Dollars]*
Are you currently raising equity?*

YesNo
How much equity are you raising? [US Dollars] [e.g. $1,250,000]*
How much equity have you already raised for this round? [US Dollars] [e.g. $250,000]*
When is your target close for the round (month/year)?*
What is the minimum check size? [US Dollars] (If there is no minimum, enter "n/a") *
How much total equity have you raised over the life of your company? [US Dollars]*
Have you established or plan to establish a special purpose vehicle (SPV) to aggregate investor checks?*

YesNo
Did you establish/plan to establish your own SPV or use/plan to use a platform/service?*

My ownPlatform/Service (e.g., AngelList, Cake, WeFunder, Republic, etc)
Which platform/service(s) are you using/plan to use to aggregate investor checks (e.g. AngelList, WeFunder, Republic, Allocations, etc.)?
Are you seeking new/additional debt funding?*

YesNo
If yes, how much debt funding are you seeking? [US Dollars]*
How much debt funding have you already obtained (i.e., current outstanding debt on your company's balance sheet plus repaid debt)? [US Dollars]*
How much grant funding have you received over the life of your company? [US Dollars]*
Have you received an investment from the members of Pipeline Angels?*

YesNo
What are the barriers or challenges you've faced in raising capital over the past 12 months? *
Is there anything unique about your entrepreneurship journey you'd like to share?
Upon completing this application, you will become a member of the IFEL community. When appropriate, we will leverage our extensive network (LinkedIn, Facebook, Newletter, WOCCON Summit, etc) to amplify you and your business. In order to ensure Founders are able to take advantage of these promotion opportunities, we request that you provide your bio, headshot and one paragraph company description below.
Please provide your bio.*

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Please provide your headshot (png or jpeg format).*

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Please provide a one paragraph company description. The paragraph should discuss you and your team/advisors, your product, the audience you serve, your go-to-market strategy and notable traction (e.g., revenue, units sold, contracts signed, etc).*

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To expedite our review of your application, kindly provide your pitch deck, if available.
Please provide the most recent version of your company's Non-Confidential Pitch Deck. [Note: if a trackable link (e.g. DocSend) is preferred instead of a direct upload of the file, please upload a document with that link provided]*

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Does IFEL have your permission to share this Pitch Deck with appropriate angels or other investors in the IFEL community?*

YesNo
Demographic Information

As a nonprofit, we are often asked to profile our client base in aggregate to communicate the general attributes of our audience. No individually identifying information will be shared. Your answers to these questions will in no way impact your eligibility for IFEL services. This information is deemed confidential.
Are you a U.S. Citizen?*

YesNo
Are you a veteran or military spouse?*

YesNo
What is your household income?*

$30,000 or less$30,001 to $50,00050,001 to $100,000$100,001 to $249,999$250,000+
Highest level of educational background?*

Less than High SchoolHigh School DegreeSome CollegeBachelor's DegreeSome Graduate StudiesMaster's Level DegreeDoctorate DegreeSpecialized technical training
Race/Ethnicity (Select all that apply).*

Asian/Asian-IndianBlackHawaiian/Pacific IslanderIndigenousLatinxMiddle EasternWhiteOtherPrefer not to disclose
Gender*
Pronouns*
Terms and Conditions: The Institute for Entrepreneurial Leadership (“IFEL”) is a non-profit that relies on the support of major donors and foundations. As a condition of receiving support, I agree to support IFEL by responding to occassional surveys and other information requests that IFEL may make in order to meet its reporting requirements.
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