ENTRENUITY COACHING SERVICES
APPLICATION

First name*

Last name*

Email*

Mobile phone number*

Gender (optional)

Ethnicity*

Business name

Website URL

What is your role in the business?*

Please describe the nature of your business and the product or service you provide*

Briefly describe your journey as an entrepreneur and why you launched or want to launch your business?*

How long have you been working on your business or business idea?*

Do you have a written business plan?*

Yes

In Process

How much time do you spend working on your business?*

Less than 10 hrs/wk

10 - 20 hrs/wk

20 - 30 hrs/wk

30+ hrs/wk

If your business is a nonprofit, do you have your Internal Revenue Service (IRS) 501 C 3 ruling documentation?

Yes

What recent milestones has your business achieved?*

If your business is operational, what was your gross sales from the previous fiscal year?

Identify the members of your team and the role of each member.*

Are you seeking investment, or plan to seek investment for your business? If so, how much and why?*

What is your biggest obstacle to growth right now?*

What are you hoping to get out of our coaching program?*

What other business coaching services have you received? Please include organization name and dates of service.

Which coaching package are you interested in?*

Plan to Launch ($550/month)

Plan to Grow ($895/month)

***Acceptable payment options for coaching services include a recurring monthly credit/debit card transaction via Stripe or a recurring monthly ACH deduction (requires completed form) and will include a $5 fee for processing. Payment via check is not permitted.***

Coaching packages include 2 or 3 hours/month of additional services. Please select the services that interest you below:

Additional Services*

Character, ethics, and leadership training

Meetings with industry experts

Plan to Launch 6-week business planning course

Budget forecast and planning

Bookkeeping services

Capital Matchmaker pitch events

Access to Mox.E events and workshops

Customer Relationship Management (CRM) software

Social media support

None

Please recommend services not listed that you would find helpful:

Limited financial assistance (up to 50% off) may be available for those who qualify. Please select your interest below:

Financial Assistance*

I am interested in financial assistance.

I can only participate if I receive financial assistance.

I do not need financial assistance.

ENTRENUITY COACHING SERVICESAPPLICATION

Coaching packages include 2 or 3 hours/month of additional services. Please select the services that interest you below:

Limited financial assistance (up to 50% off) may be available for those who qualify. Please select your interest below:

ENTRENUITY COACHING SERVICES
APPLICATION