Whether you’ve just put your business idea on paper for the first time, or you’re looking for investment opportunities for the latest tech innovation, the INPACT Initiative is here to serve you. Complete our intake form to get started on your journey with the INPACT Initiative today.

This form will take 5 to 10 minutes to complete.

Contact Information for Program Purposes

Full Business Name (include dba if applicable)*

Business Primary Contact First Name*

Business Primary Contact Last Name*

Preferred Name*

Contact Job Title*

Best Phone Number w/ Extension*

Best Email Address*

Business Physical Address Line 1 (for home-based businesses, you can omit Lines 1 and 2 if you prefer)

Business Physical Address Line 2

Business Physical Address City*

Business Physical Address State*

Business Physical Address Zip*

Is your business physical address and mailing address the same?*

Yes

Business Website

Please add up to TWO social medial platforms with the highest engagement/ activity currently.

Please provide a brief description of your business products or services.*

Demographic Information

Please indicate any active certifications that the business has, including the type and certifying agency.

Business Information

Date Company Founded

Month/Day/Year

Is your business registered with System Award Management (SAM.gov)?

Entrepreneurship Business Stage*

Ideation (thinking of a new business idea)

Planning (developing business functions and strategies)

Execution (operating the business, with or without profit)

Scaling (growing business operations and profits)

The business is organized or incorporated in the state of Indiana.

How many full-time employees does your business have?*

How many part-time employees does your business have?*

What is your current annual business revenue?*

Please select how your business identifies as SEDI-owned according to the definition below. *

(1) Self-certified the business is owned and controlled by individuals who have had their access to credit on reasonable terms diminished as compared to others in comparable economic circumstances, due to their:

a. membership of a group that has been subjected to racial or ethnic prejudice or cultural bias within American society

b. gender

c. veteran status

d. limited English proficiency

e. disability

f. long-term residence in an environment isolated from the mainstream of American society

g. membership of a Federally or state-recognized Indian Tribe -long-term residence in a rural community

h. residence in a U.S. territory -residence in a community undergoing economic transitions (including communities impacted by the shift towards a netzero economy or deindustrialization)

i. membership of an “underserved community” as defined in Executive Order 13985

i. individuals who belong to communities of color, such as Black and African American, Hispanic and Latino, Native American, Alaska Native and Indigenous, Asian American, Native Hawaiian and Pacific Islander, Middle Eastern, and North African persons

ii. individuals who belong to communities that face discrimination based on sex, sexual orientation, and gender identity (including lesbian, gay, bisexual, transgender, queer, gender non-conforming, and non-binary (LGBTQ+) persons)

iii. persons who face discrimination based on pregnancy or pregnancy-related conditions

iv. Parents

v. Caregivers

vi. individuals who belong to communities that face discrimination based on their religion or disability

vii. first-generation professionals or first-generation college students

viii. individuals with limited English proficiency

ix. Immigrants

x. individuals who belong to communities that may face employment barriers based on older age or former incarceration

xi. individuals who belong to communities that may face employment barriers based on older age or former incarceration

xii. persons who live in rural areas

xiii. veterans and military spouses

xiv. persons otherwise adversely affected by persistent poverty, discrimination, or inequality.

(2) Self-certified the business is owned and controlled by individuals whose residences are in CDFI Investment Areas, as defined in 12 C.F.R. § 1805.201(b)(3)(ii). Visit https://www.cdfifund.gov/cims to quickly determine if your residence is in a CDFI Investment Area.

(3) Self-certified the business will build, open, or operate a location in a CDFI Investment Area, as defined in 12 C.F.R. § 1805.201(b)(3)(ii)

(4) Self-certified the business is located in a CDFI Investment Area, as defined in 12 C.F.R. § 1805.201(b)(3)(ii)

Business Services Inquiry

Would you like to be added to the INPACT Initiative e-newsletter list to stay informed of the latest business resources, programs, and events for minority business enterprises?

Yes, please add me to the list

Are you interested in receiving information about getting your business certified? (MBE, DBE, VOSB, etc.)*

Yes

The INPACT Initiative hosts monthly virtual presentations covering the topics that are most valuable to your business’ growth and success. Would you like to receive personal invitations to these virtual sessions?*

Yes

The INPACT Initiative offers 1:1 specialty advising on topics of (1) certification and contracting and (2) business operations and supplier readiness. To ensure these advising sessions are the right fit for your current stage of business, we recommend starting with a general advising session through our Indiana Small Business Development Center (ISBDC) network first. This helps us tailor support and connect you with the most effective resources. Have you completed a general advising session through the ISBDC in the last 6 months?*

Yes

No, but I'd like to be referred

No, and I’m not interested at this time