LGBTQ+ Entrepreneur Bootcamp Application

First Name *

Last Name *

Pronouns *

She/Her

He/Him

They/Them

Other

Email *

Phone *

Have you already launched your business? *

Yes, we’re up and running!

No, but we’re ready to go.

Nope, we’ve got an idea but need some more help.

What industry/type of business have you launched/plan to launch? *

Why do you want to be a part of the LGBTQ+ Entrepreneur Bootcamp? *

What do you hope to gain from participating in the LGBTQ+ Entrepreneur Bootcamp? *

Please select which specific Entrepreneur Bootcamp you are applying to: *

Enter required value Statewide Virtual (February 24th-28th) Milwaukee (April 7th and 8th) Madison (June 26th and 27th) Appleton (September 11th-12th)

What is your gender?

Female

Male

Non-Binary/Third Gender

Prefer to self describe

Prefer not to disclose

Do you identify as transgender?

Yes

No

Prefer not to say

What is your sexual orientation

Gay or Lesbian

Bisexual

Straight

Queer

Questioning

Pansexual

An identify not listed above / Prefer to self describe

Prefer not to disclose

Race/Ethnicity

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of Africa.

White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East or North Africa.

Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.

Native Hawaiian or Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.

Native American or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment

Other

Prefer not to disclose

I agree to the following terms: *

1. All of the information that I have provided is true and accurate.
2. That if am accepted into the program, to commit to being an active participant during the April 18-19, 2024 Program and will attend the all-day sessions.

I agree to the terms.