Southfield Evolution Lab Application Intake Form
Contact Information
First name
Last name
Email
Phone number
City
State
Zip code
Company Information
Company name
Company description
If you are not based in Southfield, are you willing to relocate?
Please select...
Yes, I am willing to relocate to Southfield
No, I will not relocate to Southfield
Underserved categories (Check all that apply)
Women owned
Veteran owned
Minority owned
Disadvantage/underrepresented community owned
Does your business offer a product or service?
Product
Service
Both
Type of business
Please select...
Idea only
Pre revenue business
Revenue generating business
What are you seeking out of this business?
What are your current challenges?
What do you see as your top priorities to grow your business
Are you seeking funding? If yes, please describe how much and what it will be used for
How has your company been funded to date?
Is your business registered through a state or government organization as majority owned by an underserved/underrepresented class?
Please select...
Yes
No
Prefer not to answer
Contact Information