APPLICATIONS FOR THE IDEA VILLAGE ENTREPRENEUR CHALLENGE '10 ARE CLOSED. If you would like to register and keep up to date through our newsletter, please complete the entrepreneur information form below.

*Please check one from the following options:	I would like to register and keep up to date through our newsletter.
*Name of Business:
*Name of Entrepreneur:
*Company Street Address:
*City:
*State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
*Zip Code:
*Website:
*E-mail:
*Phone Number:	- - x
*Alternative Phone Number:	- - x
*Fax:	- - x
*At what stage is your business?:	[Select One] Pre-start. My business is pre-launch/pre-operation, in concept development phase. Start-up. My business is within 12 months of launch and/or pre break-even. Re-start. I am reopening my business Established. My business is more than one year from launch, with a strategic focus on sustainability. Growth. My business is more than one year from launch, with a strategic focus on scaling my venture.
*Type of Industry:	[Select One] Construction Manufacturing Transportation Energy Communication Wholesale Retail Finance & Insurance Arts, Entertainment, and Recreation Health Care & Social Assistance Services Educational Services Professional, Technical, & Scientific Services Real Estate Information Services Food & Food Services
*Current Annual Revenue:
*Current Numbers of Jobs:
*Description of Business:	(chars left: 500)
*Please identify in what areas your business needs strategic consulting support (if applicable):	Branding Financial General Business Coaching/Mentorship Human Resource Management Management Development Marketing & Advertising Operations Public Relations Strategy
Additional comments, concerns, and notes:	(chars left: 500)
*Disclaimer #1:	I certify that the above information is true and accurate to the best of my knowledge and ability.
*Criteria checklist:	I understand that this application does not guarantee that I will receive resources from The Idea Village.
*My venture meets the following Idea Village objective criteria:	Organized as a for-profit In the 7-Parish Region: Orleans, Jefferson, St. Tammany, Plaquemines, St. Bernard, St. John, and St. Charles Currently generates less than $1 million in annual revenue Currently employs fewer than 10 full time employees Has desire to grow business to more than $10 million in annual revenue in 5-10 years Demonstrates personal investment of capital and/or time in the venture
*How did you hear about The Idea Village Entrepreneur Challenge?:	Friend or Colleague The Idea Village Staff Entergy Innovation Center Staff Launch Pad News 504ward City on N.O GNO, Inc. SBDC Start Up New Orleans Good Work Network NewCorps Capital Access Project Enterprise Corporation of the Delta/Hope Community Credit Union Other:
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