Rural NC Place-Based Entrepreneurship Roundtable Application
Account Exists
Yes
Organizational Information
Diff Org?
I am applying on behalf of a
different
organization than listed below
Account ID
Organization Name
Organization Street Address
Organization City
Organization State
Organization Zip Code
Brief Description of Organization
Organization County
Please select...
Out of State
Alamance
Alexander
Alleghany
Anson
Ashe
Avery
Beaufort
Bertie
Bladen
Brunswick
Buncombe
Burke
Cabarrus
Caldwell
Camden
Carteret
Caswell
Catawba
Chatham
Cherokee
Chowan
Clay
Cleveland
Columbus
Craven
Cumberland
Currituck
Dare
Davidson
Davie
Duplin
Durham
Edgecombe
Forsyth
Franklin
Gaston
Gates
Graham
Granville
Greene
Guilford
Halifax
Harnett
Haywood
Henderson
Hertford
Hoke
Hyde
Iredell
Jackson
Johnston
Jones
Lee
Lenoir
Lincoln
Macon
Madison
Martin
McDowell
Mecklenburg
Mitchell
Montgomery
Moore
Nash
New Hanover
Northampton
Onslow
Orange
Pamlico
Pasquotank
Pender
Perquimans
Person
Pitt
Polk
Randolph
Richmond
Robeson
Rockingham
Rowan
Rutherford
Sampson
Scotland
Stanly
Stokes
Surry
Swain
Transylvania
Tyrrell
Union
Vance
Wake
Warren
Washington
Watauga
Wayne
Wilkes
Wilson
Yadkin
Yancey
Organization Website URL
Please fill out your Organizational Information below
Organization Name
Organization Street Address
Organization City
Organization State
Please select...
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
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Organization Zip Code
Brief Description of Organization
Organization County
Please select...
Out of State
Alamance
Alexander
Alleghany
Anson
Ashe
Avery
Beaufort
Bertie
Bladen
Brunswick
Buncombe
Burke
Cabarrus
Caldwell
Camden
Carteret
Caswell
Catawba
Chatham
Cherokee
Chowan
Clay
Cleveland
Columbus
Craven
Cumberland
Currituck
Dare
Davidson
Davie
Duplin
Durham
Edgecombe
Forsyth
Franklin
Gaston
Gates
Graham
Granville
Greene
Guilford
Halifax
Harnett
Haywood
Henderson
Hertford
Hoke
Hyde
Iredell
Jackson
Johnston
Jones
Lee
Lenoir
Lincoln
Macon
Madison
Martin
McDowell
Mecklenburg
Mitchell
Montgomery
Moore
Nash
New Hanover
Northampton
Onslow
Orange
Pamlico
Pasquotank
Pender
Perquimans
Person
Pitt
Polk
Randolph
Richmond
Robeson
Rockingham
Rowan
Rutherford
Sampson
Scotland
Stanly
Stokes
Surry
Swain
Transylvania
Tyrrell
Union
Vance
Wake
Warren
Washington
Watauga
Wayne
Wilkes
Wilson
Yadkin
Yancey
Organization Website URL
Applicant Information
First Name
Last Name
Title
Email
LinkedIn URL
Contact ID
Are you the above Facilitator Training Attendee?
Yes
No
Applicant Information XX
First Name
Last Name
Email
LinkedIn URL
As we have a limited number of spaces available, we may not be able to accommodate everyone who would like to attend. Tell us a little about your interest in attending the roundtable. Do you have experience or expertise with place-based entrepreneurship programs in rural communities? Or is your community actively planning a co-working, incubator, or accelerator program?
Was this your first time hearing about NC IDEA?
Yes
No
How did you initially hear about this particular application opportunity?
Please select...
Entrepreneurial Support Organization Referral
Fellow Entrepreneur Referral
Investor Referral
Media/Press Announcement
NC IDEA Newsletter
Online Search
Recommendation from NC IDEA
Service Provider Referral (lawyer, accountant, marketing agency, etc)
Social Media
Other
Please provide more detail regarding your selection above. (i.e. specific name of media outlet, social network or referring organization/individual)
Is there anything else you would like to tell us?
Contact Information