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Program Application

We are now accepting applications for the next 12-month class of the Entrepreneurial Fellows Program, which will begin in January. Are you prepared to move your business to the next level of success?

Our application process is simple:

1. Complete our online application below or contact us to receive a paper application.
2. Although there is no deadline to apply, we limit our class size to ensure that you enjoy focused attention and a personal experience. To maintain an open, comfortable environment, we do not accept competing businesses to the same class.
3. We never share information provided in an application – it’s used only to determine whether this program will meet your needs and propel your business growth.

We are always looking for experienced entrepreneurs to serve as mentors to our fellows. If you are interested in supporting our region’s enterprising business community by serving as a mentor, please tell us more about yourself.

* Required Fields

• Company Name:*

• President / CEO:

• Prefix: Mr. Ms. Mrs. Dr. Rev.
• First Name:*
• Last Name:*
• Suffix: Jr. Sr. II III IV

• Applicant Name (if different):

• Prefix: Mr. Ms. Mrs. Dr. Rev.
• First Name:
• Last Name:
• Suffix: Jr. Sr. II III IV
• Title (if applicable):
• Street:*
• City:*
• State:* Select State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington, DC
• Zip Code:*
• Web Address:
• Phone Number:*
• Cellular Phone:
• Fax:
• E-mail:

• About Your Organization:

• What is your company's primary business?:*
• Year Founded:
• Your NAICS code (see www.naics.com):
• Number of Employees:
• Geographical Markets:

• Annual Sales Range:

• $.5 - $1 million
• $1 - $5 million
• $5 - $20 million
• $20 - $40 million
• greater than $40 million

• Annual sales growth in the last 12 months:

• (+/-) Dollar Amount
• or (+/-) Percentage

• Please prioritize the concerns, issues and ideas you would like to explore through the Fellows program (#1 being the highest priority):

• #1
• #2
• #3
• #4
• #5
• #6

• About You

• What is your current role in the business?
  What are your responsibilities?
• How has your role changed since you started with the company?

• Attended College?:

• Yes
• No
• Where?:

• Degree Recieved?

• Yes
• No
• Major?:
• In order to accommodate your busy schedule, food is provided as part of the programs. Please indicate any special dietary concerns or requirements(allergy, vegetarian, etc):
•  
• I am fully committed to attending all core programs, working with a mutually acceptable mentor,and I will come prepared to embark on a voyage of lifelong learning that will result in the success of my business for many generations to come. I understand that if I am not completely satisfied after completing the one-year program, I may request a full refund of the enrollment fee.
• Name:*
• Date:*
•  
•   Submit Form

 

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