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First name*

Last name*

Personal Email*

Phone*

Are you a Bridgeport CT Resident?*

Yes

No

Single choice*

HIgh School

GED

Some College

College Degree

Some Graduate

Graduate Degree

Multi-line address

Country/Region*

Address*

Address - line 2

City*

Zip / Postal code*

Company name*

Business Industry/Type (ex: Food, Technology, Clthing, Etc.)*

Briefly Describe Your Business*

Is Your Business a Service, a Product, or Both*

Product

Service

Service or Product Name*

Do you own a Storefront?*

Yes

No

Business Email*

Business Website*

Business Social Handles*

Date (Year) Business was Started*

Business Structure*

LLC

B Corp

C Corp

Not for Profit

Not Applicable

How many employees (Including Yourself)*

Is Your Business Based in Bridgeport?*

Yes

No

Are you Running Your Business Full -time or Part-Time?*

Full time

Part Time

Are You Employed Outside Your Business?*

Yes

No

List all Business Planning, Programs and Workshops You Have Participated in. (Year // Program)*

What are Your Main Business Challenges Right Now?*

What Time of Day Can You Meet?*

AM

PM

Evening

What Day Can You Meet?*

Monday

Tuesday

Wednesday

Thursday

Friday

What Personal or Professional Product, Project or Achievement are You Most Proud Of? Please Briefly Tell us About it.*

Let’s Work Together

Get in touch so we can start working together.

First Name

Last Name

Email

Message

Thanks for submitting!

University of Bridgeport Innovation Center at Bauer Hall

82 Marina Park Cir
Bridgeport, CT 06604

Email: entrepreneurship@bridgeport.edu

Phone: 203.576.4190

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