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Stakeholder Application

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A background check, orientation, and participation in a short prospective stakeholder interview are required with the application process.

Welcome

Submit one business per application. Multiple submissions will be subject to multiple Stakeholder Plans.

Welcome to the Russell Innovation Center’s Stakeholder application!

We’re delighted that you’re applying to become a stakeholder. We are eager to learn more about you as you learn more about us. In the meantime, this application will help us get a sense of who you are as an entrepreneur. Whether you’re a startup or an existing business owner, we encourage you to complete it as thoroughly as possible. We know we’ll be impressed with the incredible skills and values you demonstrate.

Warmest wishes,
RICE Family

RICE Stakeholder Agreement

As part of our application process, we will ask that you complete a background check and participate in a short prospective stakeholder interview so that we can get to know you and your business better. Please note that If you are selected to be a stakeholder you will need to attend an orientation at RICE

1. What are your expectations from RICE?*

2. How did you hear about RICE?*

3. What are (3-5) goals for your business*

4. What challenges are you experiencing in achieving these goals?*

5. Stakeholder Plans*

Base $100

Base + Mail $125

Base + Dedicated Desk + Mail $225

Base + Dedicated Desk $200

Team Plans: Base + $50 for each additional team member (up to two team members). List team members names and email addresses added to the plan.

Team Member 1 – Full Name*

Team Member 1 – Email*

Team Member 2 – Full Name*

Team Member 2 – Email*

Personal Information

6. Name*

First Middle Last Suffix

7. Email*

Enter Email Confirm Email

8. Phone Number*

9. Alternate Phone Number (optional)

10. Address*

Street Address Address Line 2 City State ZIP Code

11. County*

12. Date of Birth*

13. Race/Ethnicity*

14. Gender*

15. Marital Status*

Emergency Contact

16. Full Name*

First Last

17. Phone*

18. Relationship to entrepreneur*

Education Background

19. Highest level completed*

20. Did you attend an HBCU?

Yes

No

22. Veteran Status*

Business Administration

23. Name of Business*

24. Your Title*

25. Business Address*

Street Address Address Line 2 City State ZIP Code

26. Business Email Address*

27. Business Phone Number

(000) 000-0000

28. Business Website

Please enter a valid Website URL

29. How many years have you been in business?*

30. EIN#*

If you don’t have an EIN#, then enter N/A.

31. What is your legal business structure?*

In which state(s)?*

Provide proof of incorporation*

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 5 MB.

Please upload your proof of incorporation document. You can provide a JPG, JPEG, or PNG file. It must be no larger than 5 MB.

32. Written business plan*

Yes

No

If yes please provide a summary in three to five sentences.*

33. Ownership Percentage*

34. Business Investors (% ownership)*

35. Business Investor names*

36. Co-Owners (% ownership)*

37. Co-Owner Name(s)*

38. Social media handle*

Facebook

Instagram

Twitter

Pinterest

LinkedIn

Other (specify)

none

Other*

Business Operations

39. Business Type – What is your customer base?*

40. Industry categories: Select one*

Other (Please specify the type of business)*

41. Please tell us about your business and/or product branding. Provide a description of your business brand. If you do not have a business but you have an idea or concept, please describe it.*

42. Business Legal Structure*

43. Select Type of Corporation*

44. Does it qualify as a small business corporation (SBC)?*

45. List any business-related licenses.

Human Resources

46. Number of Employees*

Number of full-time employees (W-2) Number of full-time employees (1099) Number of part-time employees (W-2) Number of part-time employees (1099)

47. Do you have business insurance?*

Yes

No

48. Do you have life insurance?*

Yes

No

49. Do you have a will?*

Yes

No

50. Do you have healthcare insurance?*

Yes

No

51. Do you have disability insurance?*

Yes

No

52. How many hours a week do you dedicate to your business?*

0-15

15-20

20-40

40+

53. How many hours are you available for business educational programming ?*

9:00am-12:00pm

12:00pm-3:00pm

6:00pm-9:00pm

Other

Write in range of time not listed.*

54. Do you have employment outside of your business?*

Full-Time

Part-Time

Seasonal

N/A

Business Marketing

55. Have you done the market research to test the validity, interest, ranking of your product/ services? (Check all that apply)*

Focus Group

Survey

Customer Discovery

Other (specify-write-in)

None

Other*

56. What is the value proposition or unique solution to a market need that your business provides?*

57. What impact do you, your service, or your product have on the community?*

58. Have you participated in other incubator programs?*

59. Describe your growth strategy in 3-5 sentences.*

Business Finances

60. 2019 Annual Gross Revenue*

Please enter a number greater than or equal to 0.

61. 2020 Annual Gross Revenue*

Please enter a number greater than or equal to 0.

62. 2021 Annual Gross Revenue*

Please enter a number greater than or equal to 0.

63. Identify the revenue streams currently generated by your business. (Check all that apply)*

Subscriptions

Licensing

Product Sales

Services and Consulting

Advertising

Educational Services/Training

Leasing and Renting

Brokerage Fees

Other (specify)

None

Other*

64. Have you consulted with a tax professional(s) to create your business?*

Yes

No

65. Have you consulted with the following?*

Tax Attorney

Certified Public Accountant (CPA)

Franchise (e.g., H&R Block, etc.)

None of the above

66. How did you hear about RICE?*

67. If referred, by whom? Enter N/A if not referred by someone.*

As part of our application process we will ask that you complete a background check and participate in a short prospective stakeholder interview so that we can get to know you and your business better. Please note that If you are selected to be a stakeholder you will need to attend an orientation at RICE (include orientation link).

Terms and Conditions*

I have read and agree to the website Terms and Conditions*

Untitled*

By using this form you agree with the storage and handling of your data by this website in accordance with our Privacy Policy*

Untitled*

I have read and agree to the Stakeholder Agreement

Untitled

Untitled

Number

Number

Number

Number

Number

Number

RICE is a business generator serving metro Atlanta, created to support Black entrepreneurs in overcoming the unique barriers they face in building thriving businesses. At 54,000 square feet, RICE is the largest center of its kind in the United States. Our BIG IDEAS model meets every business owner where they are on their journey, fortifying them with a community of support, increasing access and exposure, focused on transformational change. RICE honors the legacy and visionary leadership of one the greatest entrepreneurs the city of Atlanta ever produced, the late great Herman J. Russell.

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