TECH STARTUP SKILLS INCUBATOR PROGRAM APPLICATION FORM 2020 1 Contact Information2 Business Idea3 Startup Experience and Goals Your Contact InformationName* First Last Phone number*Email* Enter Email Confirm Email Address* Street Address Address Line 2 Town/Suburb ZIP / Postal Code Local Government Area*Bass Coast ShireBaw Baw ShireEast Gippsland ShireLatrobe CitySouth Gippsland ShireWellington ShireHow did you hear about Startup Gippsland?* Your BusinessWhat is the name of your startup?*Do you have a website? If so, please tell us the URL. Describe your business idea in 100 words or less.*What problem is your business or idea solving?*Describe your solution (i.e. your product or service).*Describe your solution/idea uses technology?*Who is your main customer?*Who are your main competitors?*Why are you better than these competitors?*How will you make money?* Startup Experience and GoalsHow long have you been working on your startup?*How many hours per week do you spend on your startup?*Do you have any co-founders or team members? Please list them and their roles.*What stage are you in with your startup?*Industry/desk researchProblem validation/customer researchIdea/business model developmentNon-working prototypeWorking prototype/minimum viable productDevelopment - looking for first clientsLaunched - first sales doneGrowth - increasing salesWhat are your aspirations for your startup's market?*Complete the sentence: I want to have a business whose market is...My Local council area onlyGippsland-wideVictoria-wideAustralia-wideInternationalHave you been a part of any other startup or business programs?*Have you received any funding for your startup?*Where do you want your startup to be in 6 months' time?*Where do you want your startup to be in 5 years' time?*What elements of the Startup Gippsland program are you most interested in?* Expert-facilitated training workshops Mentoring panel Social events Meeting other Gippsland-based startups Pitch event Other What other elements of the program are you most interested in?*CommentsThis field is for validation purposes and should be left unchanged.