Find Your Path - Elevate Northeast Indiana

Name*

First Last

Company Name*

Your Title*

Email*

Phone

County*

Gender*

Male
Female
Other
Prefer Not to Say

Age*

Under 18
19-29
30-39
40-49
50-59
Over 60

Please choose the option that best describes your race or ethnicity.*

American Indian or Alaska Native
Asian
African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
Caucasian
Mixed Race or Ethnicity
Prefer Not to Say

We ask about your race and ethnicity so we can track the diversity of the Elevate Northeast Indiana community.

Are you affiliated with a local school or university (student, faculty, alumni)?*

Yes
No

Which local university are you affiliated with?*

Do you have a completed product or service?*

No, I have an idea (pre-revenue)
No, I have an MVP (pre-revenue)
Yes, I have a completed product or service (pre-revenue)
Yes, I have a completed product or service (revenue producing)

What industry does your business fall under?*

Advanced Food / Agriculture
Advanced Manufacturing / Defense / Aerospace
Biotech / Life Science / Medical Devices
Technology-enabled Products & Services / Security
Other

Please describe the industry your business falls under.*

Tell us about your business venture in a few paragraphs. Make sure we understand 1) what you are selling, 2) your target customers and their need, 3) how much traction you've achieved so far (such as sales, signups, followers, other customer engagement), and 4) your vision for growth 3 to 5 years down the road.*

Please list links to any websites, articles, presentation decks, reviews, or any other online material about your project.

What can we help you with?*

Please describe how we can help you!*

How did you hear about us?*

Event
Social Media
Personal Referral / Word of Mouth
Website
Other

How did you hear about us?*

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