1. Please fill in the following information:
2. What is your company mission and vision:
3. Describe the industry that best represents your business:
4. Select the target market(s) that your business addresses:
5. Briefly describe the products and/or services provided by your business:
6. Describe strategies your organization employs to achieve blended financial, social and/or environmental impact:
7. Describe how your business model is innovative and different from existing efforts:
8. Discuss briefly the company's operations including manufacturers, suppliers, distributors, partners, etc.
9. Describe current industry risks and benefits:
10. Describe briefly the biggest challenge currently facing your business:
11. Provide short overview of major competitors:
12. Describe your growth strategy:
13. Provide short bios of the founding/leadership team:
14. How many members of the founding/leadership team are women:
15. How many members of the founding/leadership team are under-represented minorities:
16. Describe strategies your company employs to measure environmental and/or social impact?
17. Please email your current and projected (3-5 years out) financial statements to anna_koltchagova@unc.edu. Applications without financial statements will not be reviewed. 

18. Please tell us how BASE can provide value to your business. Drag and drop the following list of potential BASE resources from 1(=most important) to 10 (=least important):

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
18a. Other (please describe):
19. In order to match participants with appropriate mentor, please indicate your current funding source(s). Select all that apply:
20. In order to help us better understand your growth plan, please indicate where you anticipate seeking funding in the future. Select all that apply:
21. List the top 3 blogs or listservs that you use to keep up-to-date on sustainability issues:
22. List any businesses or sustainability consulting resources your business has used:
23. Select the top 3 books you've found most inspiring and useful in building your business:
24. Membership organizations - Below is a list of membership organizations that provide support to sustainable businesses. Please indicate whether you are a) unaware, b) aware but unaffiliated, or c) currently affiliated:
24. Membership organizations - Below is a list of membership organizations that provide support to sustainable businesses. Please indicate whether you are a) unaware, b) aware but unaffiliated, or c) currently affiliated:
   
   
   
   
   
   
   
   
25. Company affiliations - Below is a list of organizations that provide support to sustainable businesses. Please indicate whether you are a) unaware, b) aware but unaffiliated, or c) currently affiliated:
25. Company affiliations - Below is a list of organizations that provide support to sustainable businesses. Please indicate whether you are a) unaware, b) aware but unaffiliated, or c) currently affiliated:
   
   
   
   
   
   
   
   
26. Company certifications - Below is a list of company certifications for sustainable businesses. Please indicate whether you are a) unaware, b) aware but unaffiliated, or c) currently affiliated:
26. Company certifications - Below is a list of company certifications for sustainable businesses. Please indicate whether you are a) unaware, b) aware but unaffiliated, or c) currently affiliated:
   
   
   
   
   
   
   
   
   
   
   
   
   
27. In a paragraph, describe why BASE is a good fit for your organization:
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