Export Accelerator Application Download the Application Guide for more information. Question Title * 1. Business Information: Business Name Address Line 1 Address Line 2 City State Zip Code Website EIN Year Established Number of Full Time Employees Number of Part Time Employees Question Title * 2. Does your business identify as (select all that apply) Minority Owned Women Owned Disability-Owned Veteran Owned LGBTQ+ Owned Question Title * 3. Please describe your business model, including brief descriptions of the key products and services you provide, your customers, and how you differentiate your offerings. Question Title * 4. How much gross revenue did your business generate in each of the following years? 2022 2023 2024 Question Title * 5. What percentage of your annual gross revenue can be attributed to business outside the US (approximations are fine)? 2022 2023 2024 Question Title * 6. What is your current export activity? Domestic sales only, but have received interest from foreign buyers Domestic sales only, with no received interest from foreign buyers Both domestic and international sales Question Title * 7. PRIMARY PARTICIPANT (Ensure this person will be able to attend all sessions) First Name Last Name Job Title Email Phone Question Title * 8. SECONDARY PARTICIPANT (Ensure this person will be able to attend all sessions) First Name Last Name Job Title Email Phone Question Title * 9. COMMITMENT STATEMENTCheck if you agree to the following: Business commits to send two employees to attend all assigned educational programming Business commits to complete an export plan by assigned due date Business commits to provide information to gauge export success progress via survey annually for five years upon program completion Question Title * 10. On behalf of our organization, I fully understand the attendance, tuition, and reporting requirements for participation in the Heartland Export Accelerator program. We agree to fulfill those requirements if selected to participate in the program. Name Date Question Title * 11. For a more intimate learning experience and to foster robust dialogue the program will be limited to five companies (allowing for two representatives from each selected company). If your company is not selected for this cohort, would you like to be considered for subsequent cohorts? Yes No Done