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First name*

Last name*

Company name*

City*

State/Region*

Age Group*

20-29

30-39

40-49

50-59

60s+

How would you describe yourself?*

African/Black American

Asian-Indian American

Asian-Pacific American

Hispanic American

Native American

Rather not say

Two or More Races (Not Hispanic or Latino)

White

What year was your business founded?*

My Business is a*

Sole Proprietorship

Partnership

LLC

C-Corp

S-Corp

Other

Industry (USE THIS)*

Are you a founder? *

Co-Founder

Solo Founder

Not the Founder

DevelopmentStage*

Pre-launch

Just launched (under 1 year)

1-3 years

3-5 years

5-10 years

10-15 years

15+ years

How much of your business do you own?*

I own at least 50% of my business.

I have investment and own at least 20% of my business with dilution. Or. I have investment but am the largest single shareholder within my business.

I have one/two or more co-founders who are both women that bring my stake to less than 20%.

What is your primary business model?*

B2B

B2C - mix of sales channels

B2C - primarily DTC

Consulting

Other

B2C

B2B2C

Is your business offering a product, a service, or both?*

Product

Service

Both

Please briefly describe your core business or offering.*

What was your revenue last year?*

How is your business funded?*

Self-employed / Side-gig

Bootstrapped / Self-funded

Small Business / Revenue

Crowd-funded

Line of Credit / Bank Funding

Angels / Friends & Family

Venture Capital Funded

Seeking Funding

Seeking Funding*

Angel

Venture (Seed to Series A)

Venture (Series B+)

Debt / Bank Funding

Private Equity

Are you a member of The 10th House?*

Yes

Not Yet

What is the problem you're solving for families, mothers and/or children?*

Please share any traction or proof of concept for your business if you have not yet launched.

Any growth metrics you’re proud of?

How will you use this grant to accelerate your business, and how will it help you achieve your business goal/s in 2023 and beyond? Please be as specific as possible to describe how the grant would impact your business. Max 300 words.

Please view and agree to the terms and conditions. You must read and acknowledge.

Yes, I acknowledge the terms.*