Wufoo

Entrepreneur Survey

This survey serves multiple purposes—first and foremost to learn who our members are and what our companies do so that we can better serve them. PSL intends to gather specific information about each member and their company to create a membership directory. The directory will be distributed within PSL and to the outside investor community.

Participation in the membership directory is OPTIONAL. If your company is in stealth mode, you can choose to include personal information and withhold company-specific information. You can also opt out completely. No information collected will be made public without your consent.

Since our membership categories include entrepreneurs, students, investors, mentors, community officials and now technology providers, there is much we can do with the information we collect. The information and resulting directory will be a great tool for us to promote PSL and our member companies throughout the region, and will make coordinating funding-related programming much easier.

PSL is a private, grassroots group and is not affiliated with any governmental organization or university. PSL does not discriminate or make any membership decisions based on age, sex, race or religion. The demographic data we collect is only intended to help provide PSL members with funding and staffing opportunities that may become available through partner organizations.

Member Profile Information
Name * First Last
Email
Phone ### - ### - ####
Phone Extension
Professional Bio (200 words)
Maximum Allowed: 200 words. Currently Used: 0 words.
LinkedIn Profile URL
Title/Role at your company *
Company Name *
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 *
Startup Business Lifecycle Information

In order to best serve our growing start up community, PSL is gathering information about our members’ businesses to provide a general picture of our membership to investors, mentors, and civic officials. 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.
Company Web Site
Company Bio (200 words)
Maximum Allowed: 200 words. Currently Used: 0 words.
Your company's field/business area *
Business Idea
Business Plan
Busines Plan Executive Summary (Attach File)

Files will be distributed to investor membership. Please do not upload if your information is sensitive or confidential as non-disclosure paperwork will NOT be collected.
Product Prototype
Website
Intellectual Property
Patents
# of full time employees at your startup
# of part time employees at your startup
# of student interns at your startup
# of employees you expect to hire in the next year
Amount of funding to date
$ Dollars . Cents
Amount you intend to raise in the next year $ Dollars . Cents
Your post-money valuation $ Dollars . Cents
Your company's launch date (actual or expected) MM / DD / YYYY
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 company's lifecycle information to the membership directory? The information will be made public and will be distributed to the investment community. In order to include company lifecycle information, you must also agree to include your member profile information (question above). *
Yes No
Do Not Fill This Out