Step 1 of 6 16% I am applying for:(Required) Pipeline 2023 Fellowship - Pipeline’s premier Fellowship program for entrepreneurs who are working full time in their ventures. Pipeline 2023 Pathfinder - Pipeline’s newest program, exclusively created for entrepreneurs of color, who identify as womxn or who run a business in a rural community. Entrepreneurs do NOT need to be full time in their venture to apply but certainly can be. I am eligible for both programs and would like to be considered for both (must be working full-time in your venture and identify as a person of color, womxn or from a rural entrepreneur). Confidentiality Consent:(Required) By selecting Agree, you are acknowledging the implications of Pipeline's statement of confidentiality regarding your application material.Confidentiality Note: Since application materials will be used to screen and judge applicants, materials submitted will not be held in confidence and will be shared to facilitate judging. Pipeline will not guarantee confidentiality of such application material. Name:(Required) First Last Business Address:(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home Address:(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Preferred Email Address:(Required) Phone Number:(Required)Company Name:(Required) Your Title/Position in Company:(Required) Company Website:(Required) How did you hear about Pipeline?(Required)Will you be working full time on this venture? If not, please describe your work obligations:(Required) Requirements Agreement:(Required) By clicking the box, you agree that you meet the following Pipeline Fellowship Requirements below. If you have a question about the requirements, please email info@pipelineentrepreneurs.comInterview Agreement:(Required) I understand and agree that if selected, I will participate in virtual interviews and if I am unable, I will not be considered for the 2023 class. These will be the following:Pipeline Fellowship: Semi-Final Interviews: December 6-8 (VIRTUAL) Final Round Interviews: January 10-12 (VIRTUAL) Interview Agreement:(Required) I understand and agree that if selected, I will participate in virtual interviews and if I am unable, I will not be considered for the 2023 class. These will be the following:Pipeline Pathfinder Program: Interviews: December 13-15 (VIRTUAL) Interview Agreement:(Required) I understand and agree that if selected, I will participate in virtual interviews and if I am unable, I will not be considered for the 2023 class. These will be the following:Pipeline Fellowship: Semi-Final Interviews: December 6-8 (VIRTUAL) Final Round Interviews: January 10-12 (VIRTUAL) Pipeline Pathfinder Program: Interviews: December 13-15 (VIRTUAL) Module Dates Agreement:(Required) Please mark all 2023 modules with the ability to travel.Pipeline Fellowship: New Fellow Orientation: January 26, 2023 Module 1: February 22-24, 2023 Module 2: May 31-June 2, 2023 Module 3: September 13-15, 2023 Module 4: November 1-3, 2023 Innovators: April 21, 2023Module Dates Agreement:(Required) Please mark all 2023 modules with the ability to travel.Pipeline Pathfinder Program: New Fellow Orientation: January 26, 2023 Module 1: February 24-25, 2023 Module 2: June 1--3, 2023 Module 3: September 15-16, 2023 Module 4: November 3-4, 2023 Innovators: April 21, 2023Module Dates Agreement:(Required) Please mark all 2023 modules with the ability to travel.Pipeline Fellowship: New Fellow Orientation: January 26, 2023 Module 1: February 22-24, 2023 Module 2: May 31-June 2, 2023 Module 3: September 13-15, 2023 Module 4: November 1-3, 2023 Innovators: April 21, 2023 Pipeline Pathfinder Program: New Fellow Orientation: January 26, 2023 Module 1: February 24-25, 2023 Module 2: June 1--3, 2023 Module 3: September 15-16, 2023 Module 4: November 3-4, 2023 Innovators: April 21, 2023Fee Agreement:(Required) Pipeline is unique in that we do not take an equity stake in the companies of our entrepreneurs. That’s right! That’s unusual these days, but we believe in this model to attract entrepreneurs further along in their growth trajectory. The only cost associated with being in the Fellowship year is a modest program offset fee. The 2023 Fellowship fee is $2500. We believe this fee shows good faith toward participating with all of our sponsors and donors to cover the considerable expense of logistics involved in our year of modules. Payment plans are available. What is your product/service?(Required)How much outside capital have you raised with this venture?(Required)How much capital will you need to raise in the next five years?(Required)Do you have any previous experiences as an entrepreneur or with an entrepreneurial venture? If yes, please explain.(Required)Please explain past and current mentoring relationships and lessons learned from the experience.(Required)As a CEO/Founder, what is your current ownership percentage? Name the other owners/founders and their ownership percentages.(Required) Please list the industry sector of your business:(Required) Number of employees:(Required)How many years has your company been in existence?(Required) Which best describes your current stage of development of your venture in terms of revenue?(Required) Company not yet formed Company formed but no revenue Under $100,000 in revenue Under $500,000 in revenue $501,001-$999,999 in revenue $1-3M in revenue $3.5-5M in revenue Over $5M in revenue Do you have any Pipeline Members involved with your venture? If so, please explain their role.(Required)Do you own, control and/or license the property forming the basis of, and in connection with commercialization of your venture?(Required)What challenges are you facing or about to face with your venture?(Required)Please describe the entrepreneurial gaps you wish to fill during this program, professionally and personally.(Required) Please provide a link to your LinkedIn profile. If you do not have a LinkedIn profile, you can use a link to your bio.(Required) Please upload an executive summary that covers: target market, competitive advantage, business revenue/model, management team, intellectual property protection. The file can be a 5-page maximum.(Required) Drop files here or Select files Accepted file types: doc, docx, pdf, Max. file size: 10 MB, Max. files: 1. Authorization for Background Check:(Required) I understand and agree that Pipeline may complete reference and background checks prior to your acceptance as a Pipeline Fellow.NameThis field is for validation purposes and should be left unchanged.
