Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
Name of your startup (if you have one)
UW affiliation, if any:
*
University name (if attended)
Industry
*
Agriculture
Business or Consumer Services
Education
Food and Beverage
Health Care Services
Information Technology
Life Sciences and Biotech
Manufacturing
Medical Device
Non-Profit
Real Estate
Restaurant or Food Cart
Retail
Other
If other, please specify:
What stage is your startup in?
Idea/Concept
Prototype
Pilot/Paying customers
Growth/scaling
What specific VentureHome services/advice are you looking to take advantage of?
*
If other, please specify:
How did you hear about VentureHome?
*
If other, please specify:
Anything else you would like to tell us about yourself or your startup?
