Register for
The FastTrac Program at Epicenter!
Please use this form to apply for the upcoming FastTrac program cohort.
Please select the cohort you would like to apply for
Please select...
January 7 to March 11, 2025 (In Person)
Section 1: Contact Information
The following section is intended to gather your preferred contact information. This information will only be used to follow-up with you regarding your application.
What is your first name?
What is your last name?
What is your email address?
What is your phone number?
What is your mailing address?
Street
City
State
Zip Code
If accepted, I will need to pay a $50 fee.
I understand
I am unwilling to pay
Section 2: Tell Us About Yourself
The following demographic questions will help us better understand how well we are doing in reaching the entire entrepreneurial community.
The information you provide will remain confidential. This will only be shared externally as part of an aggregated summary of the information collected from all program applications.
With which gender do you most identify?
Female
Male
Gender Fluid or Non-Binary
Any gender that is not listed
Decline to share
Which category best describes you?
Asian
American Indian, Native American or Alaska Native
Black or African American
Hispanic, Latinx, or Spanish Origin
Middle Eastern or North African
Multiracial/Mixed Heritage
Native Hawaiian or Other Pacific Islander
White
Another race, ethnicity, or origin that is not listed here
Decline to share
Are you a veteran?
Yes
No
Decline to share
Section 3: Tell Us About Your Business
During the program, FastTrac participants actively work to deepen their understanding of business. Please tell us more about your business.
Business Name?
Please provide a short description of your business. T
his information is shared with program facilitators prior to the start date.
Define your ideal customer
What is your business website?
If you don't have one yet, please leave this blank.
Business address?
Street
City
State
Zip Code
About Your Business
How many years have you been in business?
Idea
0-1 years
1-2 years
2 or more years
How would you classify your business or idea? Please note that not-for profit businesses are not eligible for this program
For-profit Business
Have you generated any revenue?
Yes
No
About Your Business
Which best describes your industry/type of business?
Food and Agriculture
Restaurants Foods, and Beverages
Emerging Technology
Medical Devices
Transportation, Distribution, and Logistics
Arts, Crafts, Small Batch Production, and Makers
Creative, Film, and Music
Online or Brick and Mortar Retail
Business, Personal, or Professional Services
Other
What is your business structure?
Sole Proprietorship
General Partnership
Limited Partnership
Limited Liability Partnership(LLP)
Limited Liability Limited Partnership(LLLP)
Corporation
Limited Liability Company(LLC)
Other
My business is not yet structured
Decline to Share
Your Business Goals
What are you hoping to get out of this program?
How did you hear about this program?
Contact Information