Wufoo

Civic Leader/University Staff Survey

PSL is a private, grassroots group and is not officially affiliated with any governmental organization or university, but we are dedicated to integrating our new companies into the community.

This survey serves multiple purposes—first and foremost to learn which organizations our startups can work with to make this a thriving startup environment. PSL intends to gather specific information about each member and their company or organization to create a membership directory. The directory will be distributed within PSL and to the rest of the community.

It is our goal to increase the visibility of both our member companies and the local business community, as well as to connect local students to startup founders to keep talent in the area. We cannot be successful without more details about your organization and what you can provide to startup leaders. If a field is not applicable to your organization or you do not have enough accurate information to properly answer a question, we ask that you leave the field blank. Any information gathered will remain confidential and will only be disseminated with your expressed consent.

Member Profile Information
Name * First Last
Email
Phone ### - ### - ####
Phone Extension
Professional Bio
Maximum Allowed: 200 words. Currently Used: 0 words.
Organization/University/Employer Name *
Your title/role in the organization *
LinkedIn Profile URL
Demographic Data (private)

The demographic information collected below is intended to assist PSL in securing grants and publicity for the organization and its members. The information will not be made public and will not be included in the membership directory.
Gender *
Year of Birth *
Education *
County where you live *
County where you work *
Organization Information

In order to best serve our growing start up community, PSL is gathering information about the support within our community to provide to our startup entrepreneurs. Gathering accurate information is essential to the programming we plan to enact. If a field is not applicable to your business or you do not have enough accurate information to properly answer a question, we ask that you leave the field blank rather than give inaccurate information. The specific member or company information gathered will remain confidential and will only be disseminated with your expressed consent
Organization/University/Employer Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Organization/University/Employer Web Site
Organization/University/Employer Description
Maximum Allowed: 200 words. Currently Used: 0 words.
Are you capable of connecting PSL startups with student interns?
Yes No
Are you capable of connecting PSL startups with potential employees?
Yes No
Are you capable of connecting PSL startups with mentors or strategic advisors?
Yes No
Are you capable of connecting PSL startups with potential customers?
Yes No
Could your organization offer grants to PSL companies?
Yes No
Could your organization offer office space to a PSL for free or at a reduced rate?
Yes No
What services does your organization provide to the community?
Maximum Allowed: 100 words. Currently Used: 0 words.
Are you looking to focus your efforts on a specific topic/area?
Maximum Allowed: 100 words. Currently Used: 0 words.
In what ways could your organization work with PSL?
Maximum Allowed: 100 words. Currently Used: 0 words.
Is there anything you would like PSL to do for your organization?
Maximum Allowed: 100 words. Currently Used: 0 words.
Membership Directory Options

Please decide if you would like your information included in the membership directory. You may include as much or as little information as you wish, and participation is not mandatory.
Would you like your member profile to be included in the membership directory?
*
Yes No
Would you like to add your organization's information to the membership directory? The information will be made public and will be distributed to the startup community. *
Yes No
Do Not Fill This Out
Do Not Fill This Out