Entrepreneur Application

Disclaimer

SPARK North Texas is a project created by Champion Impact Capital in connection with a grant from the US Economic Development Administration’s Office of Innovation and Entrepreneurship. This technology platform’s purpose is to be a forum for investors and entrepreneurs to collaborate on initiatives to help the North Texas region recover from the pandemic. The system has been designed to be an educational tool only, presenting a variety of capitalization structures that may be considered by funders and entrepreneurs or project sponsors. Neither SPARK North Texas, nor any of its affiliates, make representation or warranty as to the viability of any capitalization strategy for a specific project and are not responsible for the success or failure of the entrepreneur to achieve any funding for their project.

Additionally, projects “matched” to an investor based on inputs made by investors and entrepreneurs are in no way to be considered endorsements or recommendations for investment. This system is merely a platform for engagement and should not be construed to be providing investment advice. Champion Impact Capital and its affiliates make no representations or warranties, expressed or implied, as to the adequacy or accuracy of the information contained in this system and nothing herein is or shall be relied upon as a promise or representation or warranty whether as to past or future events. Prospective investors are not to construe the contents of this system or any other communication from SPARK North Texas or its affiliates as providing assurances, whether expressed or implied, that the investment objectives desired by Investors will be realized or that any benefits or advantages to prospective investors of an investment in the projects herein suggested, implied or advocated in this system will be available or accomplished. All information contained herein has been input by third parties. In all cases, investors and donors must conduct their own examination of the materials herein and base their decisions upon their own expertise, criteria, or analysis.

I have read and agree to these terms

Additional Terms

This platform has been funded through a government grant that seeks to help North Texas recover from the pandemic through health, safety, or economic technology solutions. We will be required to provide reporting on the successful implementation of our KPIs. It is a requirement that you abide by the terms and conditions here, including ongoing use of this portal to track deal progression and completion of an annual survey to share your views about the impact of the investment. Entrepreneurs consent to reference and background checks, as well as to provide additional materials, if requested, as part of the due diligence process.

I have read and agree to these terms

Page 3

YOUR CUSTOMER

Select your customer/beneficiary (all that apply):

GovernmentBusinessesConsumers
Other

Describe how/will you price your product (25 words)

Describe how/will your customers find your product (25 words)

BUSINESS MODEL ASSESSMENT

Has your business been formally organized/incorporated?

If so, what is your structure?

LLC or LP (for profit)C-Corp (for profit)S-Corp (for profit)Sole Proprietorship (for profit)Nonprofit corporation (not for profit with or without 501(c)(3) designation)Hybrid (more than one entity with differing legal structures)

Which of these returns do you or will you generate? Please weight them in importance so that they total 100%. If a selection is not relevant to you, use 0%.

	Percent %
Financial, but not profit-maximizing	%
Financial, profit-maximizing	%
Social (returns to specific populations or society overall)	%
Environmental	%

How is your business funded today (or how do you expect your business to be funded)?

Founder-funded, friends, family

Investor-funded/equity

Bank or SBA loans

Grants/donations

Earned revenue supplemented with other sources

Retained earnings/profit reinvestment

Rank the following stakeholders in order of importance to your project/business (with one being most important):

	Rank Order (1-5)
Investors/equity partners/Shareholders
Customers who buy your product/service
Beneficiary stakeholders who do not purchase anything
Your local community
Humanity as a whole

Page 4

PROJECTED IMPACT

If you were wildly successful, what would that look like? (250 words):

Does your project has the potential to save the government money?

Will your project create jobs?

If so, how many during the next 10 years?

Briefly describe what those jobs look like (title, compensation)

Please briefly describe any validation of market acceptance of your solution or research that provides evidence of effectiveness (250 words):

Can your solution scale to markets beyond North Texas? How able are you to scale? (250 words):

Please provide a summary of the timeline for your project and any key milestones (200 words)

How will you measure results? (200 words)

What barriers are there to success and how will you mitigate those risks? (150 words)

Please provide a bibliography of any references you’ve cited (200 words):

LOCATION

Does your project include a real estate component?

Does/will your business own its own facilities?

Page 5

RESOURCE REQUIREMENTS

Key words (five words for search). Please separate words with commas.

What level of investment are you seeking and how does that compare with your overall project costs? Please provide a brief narrative of your project's budget (200 words)

Budget: Please provide a high-level summary of how you will use the funds you are seeking.

	Budget Item	Amount
Item 1		$
Item 2		$
Item 3		$
Item 4		$
Item 5		$
Item 6		$
Item 7		$
Item 8		$
Item 9		$
Item 10		$

Total Budget Amount

$

What other resources might be required? (100 words):

Number of employees currently employed at your company:

Current budget in US dollars:

$

FILE UPLOAD

Please upload the following documents, where applicable. The file name should make it clear which document it is. Click "Add another document" at the bottom right of this section to upload additional items.

Organizational document (Articles of Incorporation/Organization)
Three years' (audited preferred) financial statements (if entity is less than three years old, please provide all available)
If a nonprofit, three years 990s (or all available)
If technology has been patented, please provide evidence of such
List of entity shareholders/unitholders and officers
List of major funders
Current year corporate/project budget
Resumes of all founders and officers
If nonprofit, IRS Letter of Determination
If for profit, certificate of good standing

Document Upload:

IDENTIFICATION UPLOAD

Please upload a copy of your drivers' license for a mandatory background check.

Document Upload: