High Potential Start-Up Grant Program Application


Please complete the form below if you are an entrepreneur looking for an initial grant for your company and are located in the North Central, Northeast, or Southwest regions of Indiana. Check the list of counties to see if your location has grants available

Contact Information
To be completed by company owner, principal, or executive.
First name: *
Last name: *
Job title: *
Years of relevant industry experience: *
Work phone: *
Cell phone:
Email address: *
How did you hear about us? *



Qualifying Questions
Is your company pre-revenue? *
Yes No


Is your company in the ideation/incubation stage? *
Yes No



Company Overview
Company name: *
Address: *
City: *
County:
For Indiana-based companies
Zipcode : *
Website:
Industry: *
NAICS code: *
NAICS codes are 6 digit numbers. You can look them up here.
Company structure: *
When was your company incorporated?
Is a principal of the company a U.S. Military Veteran: *
Is the company minority owned, controlled or led: *
Minority owned means at least 51% of assets.
Minority controlled means at least 51% of voting equity.
Minority led means at least one C-level executive.
Is the company woman owned, controlled or led: *
Woman owned means at least 51% of assets.
Woman controlled means at least 51% of voting equity.
Woman led means at least one C-level executive.
Number of current employees: *
Part time and seasonal jobs should be based on a 2,000 hour year.
Number of projected employees in 5 years: *
Part time and seasonal jobs should be based on a 2,000 hour year.
Current average salary per employee: *
Please upload an Executive Summary of your grant application * Executive Summary guidelines for the application can be found here



Intellectual Property
Feel free to elaborate on your IP situation (patents, trademarks, etc.) here:



Application Specifics
Provide a brief summary of your company / product / idea: *
What is the amount of the grant you are seeking*
How much private capital have you raised, if any?
How much capital have you raised from other public sources (non-SSBCI)?
Please let us know which other investment firms / groups you have spoken to or plan to speak to:
Any additional thoughts or comments about how we can help your company:



Additional Documents
If you have documents such as investor presentations, financial models, or collateral materials that you think would be helpful to us in reviewing your application, please upload them here.

The maximum size for an uploaded file is 20 megabytes. If your file is larger, please put it on Dropbox or an equivalent service and share a link with us in the additional comments box above.




Please be patient when submitting the application, especially if you're attaching additional documents.
Once the submission is complete, you will receive confirmation on-screen as well as through email.
By submitting your application you agree to sign-up for the Elevate Ventures newsletter.
If you do not get a confirmation email, we did not receive your application.