Applicant Information First Name*
Last Name*
Residential Address*
State / Province*
Postal Code*
City*
Email*
Age Range* Please enter data 18-24 years old 25-34 years old 35-44 years old 45-54 years old 55-64 years old 65-74 years old 75 years or older
Phone Number*
Primary Language of Study*
Education Level* Please enter data No schooling completed Nursery school to 8th grade Some high school, no diploma High school graduate, diploma or the equivalent (for example: GED) Some college credit, no degree Trade/technical/vocational training Associate degree Bachelor’s degree Master’s degree Professional degree Doctorate degree
Position Title*
Company Details Company Name*
Company Full Address*
Are you applying for the Business Bounce Back program with an existing business or are you planning on launching a new business?*
Company Description*
Does your business have a co-founder?*
Sector* Please enter data Agriculture, Forestry, Fishing and Hunting Mining, Quarrying, and Oil and Gas Extraction Utilities Construction Manufacturing Wholesale Trade Retail Trade Transportation and Warehousing Information Finance and Insurance Real Estate and Rental and Leasing Professional, Scientific, and Technical Services Management of Companies and Enterprises Administrative and Support and Waste Management and Remediation Services Educational Services Health Care and Social Assistance Arts, Entertainment, and Recreation Accommodation and Food Services Public Administration Other Services
Company Website
Company Email
Company Phone
Instagram
Twitter
Facebook
What type of digital tools are you comfortable with using for day-to-day activities? (i.e. Facebook Business Suite, Twitter, Slack, Trello, Dropbox etc.) *
What are your top business goals in the next 3 months?*
What are you hoping to gain out of the program in the next 3 months? *
Have you worked with a business coach or mentor in the past? *
If you are starting a new business, please answer the following questions. What is the problem that your business is trying to solve? *
What makes your solution different and unique?*
What type of Market Research have you done to validate that there is a need for your solution?*
What type of work have you started to test or build out this new business opportunity?*
Who is your main target market?*
What is your competitive advantage?*
What is your revenue model? What channels do you plan to use to sell?*
Identify areas where you need immediate support*
If you own an existing business, please answer the following questions. Year established and/or incorporated*
Number of employees (Full Time & Part Time)*
What is the biggest challenge that you’ve faced in the past year? (i.e., setting up an online shop, driving sales online, etc.) *
What type of impact has the pandemic had on your business?*
Revenue lost during pandemic (since March 2020)*
Ecommerce (Yes or No)*
Are there new business opportunities that you’ve identified for your business? If yes, what are they?*
How did you come across this new business opportunity? Why is it important to you?*
In a concise one or two sentences, summarize the benefits of the new product/service through this business opportunity*
What type of work have you started to test or build out this new business opportunity?*
What is your main target market? Is it different than before? If yes, please tell us why*
What is your competitive advantage?*
What are your revenue models? What channels do you plan to use to sell?*
Identify areas where you need immediate support*
