Jackson Drysdale Veteran Incubator Application Question Title * 1. In order to apply for admission to the GI Go Fund Small Business Incubator, please read the following information about the requirements and the criteria with which we choose Incubator clients. If you feel that you meet the requirements and would like to apply to the program, below is a list of steps to be completed. Please contact us at 866-389-4446 should you have any questions or wish to schedule an appointment to meet with the Program Manager and/or tour the facility.MINIMUM QUALIFICATIONS FOR CLIENTS - Prior to acceptance, applicants and businesses must comply, or agree to comply, with all applicable local, state and federal regulations and ordinances, including applicable environmental laws. - Business must not require use of manufacturing or chemical production. All incubator space provided will be in an office building, or be available virtually.EVALUATION CRITERIA Applicants will be evaluated based on the following key criteria: - Potential for business growth and job creation. - A need for the services of the Incubator and a willingness to accept assistance when indicated. - The ability of the business to help diversify the local economy. - The viability of the business and its potential for success. - The business’ marketing opportunities and approach. - The business’ management team. - Resources available to the business. - Technologies appropriate to the business. - The compatibility of the business with the Incubator program and facility. STEPS FOR CLIENT SELECTION -Complete the application and submit by one of the following: Mail or in person to: GI Go Fund1 Gateway Center, Suite 760 Newark, NJ 07102 Email: james@gigo.org Phone: 866-389-4446 Fax: 732-377-8032 - We will review your application and you will be notified if your business is eligible for consideration. An appointment will be scheduled for a site visit and to discuss your application. You may need to then submit a copy of your business plan, including financial statements. If necessary, a second meeting will be scheduled to discuss the business plan. Members of the Selection Committee will review the business plan and if the business meets the evaluation criteria, and a meeting with the Selection Committee may be scheduled. You may be asked to meet with the Selection Committee at which time they may request additional information to establish or verify that the minimum qualifications are satisfied. You will be notified of their decision at the end of the meeting. I Understand and Agree to proceed with my application OK Question Title * 2. Date Date Date OK Question Title * 3. Personal Contact Information Applicant Name Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Phone Number OK Question Title * 4. Website (if you do not currently have one, type n/a) OK Question Title * 5. Business Contact Address Company Name/Proposed Company Name Business Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Phone Number OK Question Title * 6. Is your business new or existing? New Existing OK Question Title * 7. If it is an existing business, how long has it been in existence? OK Question Title * 8. If this is a new business, what steps have you taken towards establishing your business? (150 words) OK Question Title * 9. Describe the stage of development your business is in at this time: (250 words or less) OK Question Title * 10. Ownership Type Sole Proprietorship Partnership/LLC Corporation Other OK Question Title * 11. Names, addresses, phone numbers of additional principals, partners, or major shareholders: OK Question Title * 12. Briefly describe your business, its products and markets: (350 words or less) OK Question Title * 13. Describe your background or experience with the product/service of the business: (350 words or less) OK Question Title * 14. Do you have a product or technology that can be patented, trademarked or protected from duplication (if applicable)? OK Question Title * 15. Your reason for seeking entry into the program: (500 words or less) OK Question Title * 16. How much money do you have invested in this business? OK Question Title * 17. How do you intend to capitalize or finance this business? (500 words or less) OK Question Title * 18. Estimated number of employees at time of occupancy: Full-time Part-time OK Question Title * 19. Estimated number of employees after one year Full-time Part-time OK Question Title * 20. Two Years Full-time Part-time OK Question Title * 21. Three Years Full-time Part-time OK Question Title * 22. Do you anticipate your business having special facility needs (high voltage, refrigeration, special security, etc.)? If yes, please explain OK Question Title * 23. Do you expect to use any hazardous or toxic materials? If so, describe: OK Question Title * 24. Do you currently have the following? (Check all that apply): Business plan Business plan outline Market/feasibility study Required business permits Current financial information for business and/or principals OK Question Title * 25. Do you need assistance to create or complete your business plan? Yes No OK Question Title * 26. What are your business strengths? (150 words or less) OK Question Title * 27. What potential problems do you foresee in your business, and/or in entering your market? (350 words or less) OK Question Title * 28. Check areas of assistance your business needs beyond office space: Strategy Management Financial Assembly/Manufacturing Legal Facilities Technical Marketing Other (please specify) OK Question Title * 29. Requested date of occupancy Date Date OK Question Title * 30. Are you a Military Veteran? Yes No OK Question Title * 31. If not, are you the spouse, child, or dependent of a veteran? Yes No OK Question Title * 32. Did you serve in a combat theater? Yes No OK Question Title * 33. If yes, which one? OK Question Title * 34. What branch did you serve in? OK Question Title * 35. Date of Discharge Date Date OK Question Title * 36. Type of discharge Honorable Other than Honorable General/Medical Dishonorable OK Question Title * 37. Please provide any additional information you feel is relevant (350 words or less): OK Question Title * 38. Are you a person of color? Yes No OK Question Title * 39. Are you a person with a disability? Yes No OK DONE