A Program of the Institute for Entrepreneurial Leadership
VC-in-Residence Application
Fall 2024
1. Name
*
First Name
Last Name
2. Pronouns
*
3. Job Title, Employer
*
4. Gender
*
5. 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
6. Email
*
example@example.com
7. Mobile Number
*
Please enter a valid phone number.
8. LinkedIn Profile
9. 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.
10. 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
11. In which city are you based?
*
12. State
*
13. Country
*
14. Can you commit to pay the US$5,950 program fee?
*
Yes
No
15. Are you applying with a friend?
*
Yes
No
What is their name?
16. Have you ever invested in a for-profit startup?
*
Yes
No
17. What excites you about Pipeline Angels?
*
18. What do you hope to learn or gain through Pipeline Angels?
*
19. 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$5,950 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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