Reinventing Delaware – Phase One Scoping Intake Form

The following questions will help us capture more information about you and your idea to prepare us for the first phase of the program. Answers will be kept internal. Please answer truthfully.

Your Name(Required)

First Last

Your Address(Required)

Street Address Address Line 2 City ZIP Code

How Can We Reach You?

We would love to chat with you. How can we get in touch?

Preferred Method of Contact

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Best Time to Call You(Required)

Team Members & Roles: List any additional team member(s). Include emails and indicate if you plan to include them in the sessions moving forward. Type NA if not applicable.

Briefly introduce yourself and tell us why you started your business. Include your level of experience within your industry.(Required)

Idea Information

Why did you choose to apply to Reinventing Delaware?(Required)

Give a high level description of what your idea is about and what you are hoping to achieve.(Required)

Think about: What problem does your idea aim to solve, and why is it important? Who will benefit from your idea (your target audience or customers)? What makes your idea unique or different from what already exists? What impact do you hope your idea will have in Delaware or your community? What does success look like for this idea in the next 12–18 months?

Do you have a business plan?(Required)

Yes

Industry (Select the answer that best applies)(Required)

What areas will benefit from your idea?(Required)

New Castle County

Kent County

Sussex County

Delaware (Statewide)

Status of your idea (select all that apply)(Required)

If you selected "Other":

Is your idea already launched?(Required)

Yes

What is your business structure? (If applicable)(Required)

Corporations (C-Corp and S-Corp)

General Partnership

Limited Liability Company (LLC)

Limited Liability Partnership (LLP)

NonProfit

Not Incorporated (Idea Stage)

Sole Proprietorship

Program

Launch or Growth Challenges (select all that apply)(Required)

Launch or growth challenges if answered "other"

Website

File(Required)

Drop files here or

Max. file size: 2 MB.

Please upload a headshot of yourself, as well as any team member photos or logos you’d like us to have.

We partner with many organizations within the entrepreneurial landscape. It is helpful to know who you are already working with so we can make the most appropriate recommendations to best support your growth.

Are you currently working with any organizations, consultants, service providers or participating in other incubator or accelerator programs?(Required)

Yes

Please explain:

Organizational Structure

Is this your first entrepreneurial endeavor?(Required)

Yes

Is this business your primary source of income?(Required)

Yes

Capacity(Required)

1-2 Founders working full-time

2+ Founders working full-time

1-2 Founders working part-time

2+ Founders working part-time

Other

PDFF aims to be welcoming and inclusive. The first step to inclusivity is data collection. Some of the questions asked within this section are required for data collection purposes only and will not affect your eligibility to move forward.

Ethnicity (Check all that apply):(Required)

Asian

Black, African American, Black British, Caribbean

Hispanic/ Latino

Indigenous of Native Peoples

Multiple racial/ ethnic groups

North African/ Middle Eastern descent

White

Another race or ethnicity

Prefer not to disclose

Gender(Required)

Male

Female

LGBTQ+

Non-binary/non-conforming

Prefer not to respond

Age(Required)

Is your annual household income under $58k per year? We ask this question specifically on behalf of our funding partners to report on the percentage of individuals who classify as low to moderate income (LMI) persons. Your answer will be kept confidential.(Required)

Yes

Social, Environmental and Workforce Impact

Does your business incorporate social, environmental and/or workforce impact in its business model?(Required)

Yes

Social, Environmental and/or Workforce Impact If you answered "Yes" briefly explain how it is incorporated into your model. Enter NA if not applicable

Level of Impact(Required)

No attention

Little attention

Moderate attention

High level of attention

How many new employment opportunities will your business create within the next three years?(Required)

Acknowledgement

Would you like to subscribe to our e-newsletter and receive email nofications for upcoming events and announcements?(Required)

Yes

I recognize that the Pete du Pont Freedom Foundation is a 501(c)(3) nonprofit organization, and I am fully aware of the organization's mission, vision, and values. I understand that I do not speak for the Pete du Pont Freedom Foundation or any of its initiatives, including E3, and I will act in good faith regarding the promotion of the Pete du Pont Freedom Foundation and its initiatives. I am aware that the information obtained in this application may be shared with affiliates of the Pete du Pont Freedom Foundation, including but not limited to board members, staff, committee members, and partners. I agree to share data about my business or organization as requested by PDFF and complete 30-day, 90-day, and annual surveys in a timely fashion. I understand that this data is essential for the sustainability of our programming. I acknowledge that photography and/or video footage may be obtained during Pete du Pont Freedom Foundation meetings and events for promotion and marketing purposes, and I give permission for my image to be used. Additionally, I agree to allow my name and business to be included in, but not limited to, the Pete du Pont Freedom Foundation website, social media, and news releases.(Required)

I agree

I do not agree