Founders Program – Ascent & North Star Application Form

Founders Program Ascent North Star Application Form

Information that is provided remains confidential and will only be used for internal purposes.

Tell us about you
Applicant Name*
First Last
Applicant Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Applicant Email*
Applicant Phone*
Do you identify as any of the following:*
There are a variety of funding options available that North Forge may be able to identify for your startup. May select more than 1 option.
What skills and experience do you bring to the business?*
Experience, education, etc.
Tell us about your co-founders
If you do not have co-founders, please disregard this section.
Co-founder name(s)
Co-founder address(es)
Please put in order of previously listed co-founders.
Co-founder email(s)
Please put in order of previously listed co-founders.
Co-founder phone number(s)
Please put in order of previously listed co-founders.
What skills & experience do your co-founder(s) bring to the business?
Experience, education, etc.
Tell us about your business
Company name*
Company address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is your business registered or incorporated in Canada?
- Registered
- Incorporated
May select more than 1 option.
Who will be the primary contact for the business?*
Must be a founder or co-founder
How much time can you (and co-founders if applicable) commit to working on your startup each week?*
How would you best classify your business?*
May select more than 1 option
Does your solution, or part of your solution, require industrial design, prototyping and/or manufacturing?*
What are your next milestones for the business?*
How did you hear about us?*
What stage of the North Forge Founders Program would you like to be considered for?*
Ascent: build and grow. North Star: rapid and accelerated growth
If you are applying to the Ascent stage, please provide the following (all required):
Business Plan and/or Business Model Canvas or Lean Canvas
Please attach in PDF format.
Pitch Deck
Please attach in PDF format.
2 year cash flow projection
Please attach in PDF format.
If you are applying for the North Star stage, please provide the following (all are required):
Business Plan and/or Business Model Canvas or Lean Canvas
Please attach in PDF format.
Pitch Deck
Please attach in PDF format.
3 year cash flow projection
Please attach in PDF format.
Fiscal year end (or year to date) income statement, balance sheet, and cash flow statement
Please attach in PDF format.

DARE TO DO

FIND A LOCATION

WINNIPEG

CEO: Joelle Foster

441 – 100 Innovation Drive
Winnipeg, Manitoba R3T 6G2• P: 204-262-6400

PINAWA

President: Shane Li

24 Aberdeen Avenue
Pinawa, Manitoba R0E 1L0 • P: 204-753-5170

WINNIPEG

Vice-President: Marney Stapley

125 Adelaide Street
Winnipeg, Manitoba R3A 0W4 • P: 204-799-2033

THE PAS

University College of the North
436-7th Street East, The Pas, Manitoba R9A 1M7
(204) 623-0311

Founders Program – Ascent & North Star Application Form

Founders Program Ascent North Star Application Form

Tell us about you

Tell us about your co-founders

Tell us about your business

If you are applying to the Ascent stage, please provide the following (all required):

If you are applying for the North Star stage, please provide the following (all are required):

FIND A LOCATION

WINNIPEG

CEO: Joelle Foster

441 – 100 Innovation Drive Winnipeg, Manitoba R3T 6G2• P: 204-262-6400

PINAWA

President: Shane Li

24 Aberdeen Avenue Pinawa, Manitoba R0E 1L0 • P: 204-753-5170

WINNIPEG

Vice-President: Marney Stapley

125 Adelaide Street Winnipeg, Manitoba R3A 0W4 • P: 204-799-2033

THE PAS

University College of the North 436-7th Street East, The Pas, Manitoba R9A 1M7 (204) 623-0311

Founders Program Ascent North Star Application Form

Tell us about you

Tell us about your co-founders

Tell us about your business

If you are applying to the Ascent stage, please provide the following (all required):

If you are applying for the North Star stage, please provide the following (all are required):

441 – 100 Innovation Drive
Winnipeg, Manitoba R3T 6G2• P: 204-262-6400

24 Aberdeen Avenue
Pinawa, Manitoba R0E 1L0 • P: 204-753-5170

125 Adelaide Street
Winnipeg, Manitoba R3A 0W4 • P: 204-799-2033

University College of the North
436-7th Street East, The Pas, Manitoba R9A 1M7
(204) 623-0311