Before completing the application form below, please carefully review our requirements for participation:

• For-profit venture
• Located in Orleans Parish (or the ability to demonstrate economic impact in Orleans Parish)
• Current revenues not exceeding $5 million
• Demonstrated proof of concept through one or more of the following: revenue, customers, jobs, or market research supporting the need for the product or service
• Display potential for job creation in the New Orleans region
• Committed to rebuilding and growing business in New Orleans
• Open to receiving professional coaching
• Agree to report quarterly to The Idea Village on the progress of the venture

If you do not meet all of our requirements, please visit this website where you may find more appropriate resources from our partners.

If you believe that you meet our preliminary requirements outlined above, please consider whether your venture fits into one of our current areas of focus:

BUSINESS/COMMERCIAL CORRIDORS
   •Current corridor initiatives include: N. Galvez St.  (Upper 9th Ward)
   •(Corridors receiving continued support include: Oak St, Freret St, Bayou Rd, Magazine St, and OC Haley Blvd.).

CRITICAL INDUSTRY SECTORS
   •Current industries include: Green/Sustainable Businesses
   •(Previous industries have included: Musicians, Artists, Tourism, Child care and Po-Boy)

GROWTH ENTREPRENEURS
   •Scalable businesses
   •Growth issues, not survival issues

If after reviewing the requirements, you believe that your business qualifies for one of these focused initiatives,  please proceed to the application. Please take the time to provide thorough responses to the questions. The information you provide is necessary for us to properly assess your business and determine if we have the appropriate resources to assist you.

If you prefer to fill out the application offline, you can download the word version and return the completed form by e-mail to innovation@ideavillage.org, or fax to (504) 304-3294.

*Name of business:
*Business contact:
Busines owner(s), if different than contact:	(chars left: 500)
*Business street address:
*City:
*State:	[Select One] 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:
Mailing Street Address, if different than business address:
Mailing City:
Mailing State:	[Select One] 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
Mailing Zip Code:
*Business Phone Number:	- - x
Alternative Phone Number:	- - x
Fax:	- -
*Email Address:
Website:
*Type of industry:	[Select One] RETAIL Antiques Art Auto Parts Beauty Supplies Bikes & Motorcycle Books & Magazines Clothing & Accessories Furniture & Fixtures Galleries Gifts & Souvenirs Grocery & Convenience Hardware & Building Supplies Housewares Jewelry Music & Video Musical Equipment Nurseries & Florists Office & School Supplies Pharmacies Photography Toys FOOD SERVICE Wine & Spirits Bakeries & Delis Bars Catering Coffeeshops Ice Cream & Sno-balls Po-Boys Restaurants SERVICE Accounting Architecture Artists & Musicians Auto Repair Beauty & Barber Child Care Computer/Internet Dental Eyecare Financial Funeral Homes Health & Fitness Heating & Cooling Insurance Laundromats & Dry Cleaners Law Lawn Care/Landscaping Lodging Medical Museums Notaries Pet Care & Shops Picture Framing Printing & Paper Real Estate Security Signs Tailors Telecommunications Tours & Transport Tutoring CONSTRUCTION Deconstruction Demolition Electrical Flooring General Contractor General Repair Green Plumbing Roofing WHOLESALE Or:
*Were you in business pre-Katrina?	Yes No
*What was your pre-Katrina revenue?
*How many employees did you have pre-Katrina, including yourself?
*Are you currently in operation?	Yes No
*When did you start business operations?	Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Year 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
*Current number of employees, including yourself?
*What was your gross revenue last fiscal year?
*What is your projected gross revenue for this fiscal year?
*Business structure:	Sole proprietorship Partnership LLC Corporation N/A Other:
*Do you have a federal tax ID #?	Yes No N/A
*Do you have a current business license?	Yes No N/A
*What type of business insurance do you have?:	Business insurance types: General liability Workman's comp Property and contents None What type of business insurance do you have?: Other:
*What is your financial recordkeeping system?	(chars left: 250) (quickbooks, excel, ledger, etc)
*What kind of tax returns did you file for the year 2007?	[Select One] Personal Corporate Both None
*Do you have a business plan?	Yes No
Please rank your business in the following areas: Rank 1-5 1-Very weak, 3-Average, 5-Very strong
*Human resources and staff management:	1 2 3 4 5
*Marketing and public relations:	1 2 3 4 5
*Revenue model and cash flow:	1 2 3 4 5
*Legal resources:	1 2 3 4 5
*Accounting and bookkeeping:	1 2 3 4 5
*Web presence:	1 2 3 4 5
*Business Strategy and Planning:	1 2 3 4 5
*Operations:	1 2 3 4 5
*Access to capital:	1 2 3 4 5
*Sales:	1 2 3 4 5
*Simply articulate the basics of your products/business idea: what do you do?	(chars left: 1000)
*What are your business goals?	(chars left: 1000)
*Please explain your revenue model and how you make money:	(chars left: 1000)
*Describe why your idea/business is unique, necessary, and defensible:	(chars left: 1000)
*Describe your experience that is relevant to this venture:	(chars left: 1000)
*In which of the following areas are you seeking assistance from The Idea Village?	Strategic Planning Financial Management Marketing Business Expansion Operations HR & Personnel Management Legal Access to capital Other:
*How did you hear about The Idea Village?	[Select One] Good Work Network ECD HOPE Community Credit Union NewCorp Louisiana Association of Non-Profits (LANO) Urban League Mercy Corps Capital Access Project, Small Business Development Center (SBDC) SEEDCO Stay Local! City of New Orleans News The Idea Village Website Or:
*Are you receiving services from any other local agencies/institution s/consultants?	Yes No
If yes, please choose from the following:	[Select One] Good Work Network ECD HOPE Community Credit Union NewCorp Louisiana Association of Non-Profits (LANO) Urban League Mercy Corps Capital Access Project Small Business Development Center (SBDC) SEEDCO Stay Local! City of New Orleans Or:
*Please identify who, if anyone, from The Idea Village staff referred you to our program?:	[Select One] No one Tim Williamson Allen Bell Keith Crawford Lauren Baum Daryn Dodson Miji Park Emily Mitchell Kim Powe Nicky Cohen-Henriquez Jeff Sandman
Personal Information-	The Idea Village is required to collect the following information. This information will in no way affect your admission into The Idea Village programs, and will remain confidential.
*Gender:	Male Female
*Ethnicity:	[Select One] American Indian/Alaskan Native Asian Black or African American Hispanic Native Hawaiian or other Pacific Islander White Or:
*Date of Birth:	(MM/DD/YYYY)
*Total number of adults and children in household:
*Household income, please choose from the following:	[Select One] < $25,000 $25,000-$50,000 $50,000-$75,000 $75,000>
Please list 2 references:	(colleagues, employers, vendors & business associates)
*First reference's name:
*Relationship:	[Select One] Colleagues Employers Vendors Business associates Family
*Phone number:	- - x
*Second reference's name:
*Relationship:	[Select One] Colleague Employer vendor Business associate Relative
*Phone number:	- - x
*Disclaimer #1	I certify that the above information is true and accurate to the best of my knowledge and ability.
*Disclaimer #2	I understand that this application does not guarantee that I will receive resources from The Idea Village.
*Image Verification:	Enter the code above.