First Name

Last Name

Email

Phone

I Identify As Male Female I'd Rather Not Say

Are you a Canadian Citizen or Permanent Resident? Yes No

Company

I am: Starting a new business Expanding an existing business

Business Address (Unit Number, Street Number, Street Name)

City

Province

Country

Website

Business Ownership Sole proprietorship Partnership Limited liability company Corporation Cooperative

Interested in (Check all that apply): Growing my business in other countries Strengthening my entrepreneurial skills Networking/Matching opportunities To select multiple choices, hold Ctrl and select your choices.

Business Description Briefly describe your business and the products and/or services it provides

Target Market Briefly describe your target market, including: Age, Education, Income, Location, Lifestyle, Gender, Etc. For B2C: Business size, Location, Sales, Number of employees, Industry, etc.

Competitive Advantage What makes your company stand out from the competition?

Experience/Education in Industry What experience, education and connections do you have in your industry?

Challenges to Address Through Program What are you current challenges you would like to address through the mentorship program?

Program Participation Goals/Outcomes What are you key goals with the mentorship program?

Certification/Signature I Agree I Disagree By selecting "I Agree" to this question will act as your electronic approval upon submission of this form.

Do you identify with any of the following underrepresented groups? Please check all that apply. (Note* Priority to participate in this program will be given to women from the following underrepresented groups) (a) Women in Technology Indigenous women Rural women Newcomer to Canada Visible and/or racialized minority Women with a disability Women under 40 I do not identify with any of the above groups

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