Founders Club Application Applications will be accepted on an ongoing basis. Eligibility Enrolled University of Iowa undergraduate, graduate and PhD students who are serious about starting and growing a business are eligible to apply for the Founders Club. Both individuals and teams are welcome. The student(s) must be the founder or co-founder of the company. Admission Criteria The criteria for admission into the Founders Club program includes: 1.) Ability to articulate business model and entrepreneurial opportunity 2.) Desire or motivation to succeed 3.) Must be enrolled in classes at University of Iowa How many team members does your business have? * OneTwoThreeFourFive Team Member 1 (Primary) Information The primary business contact MUST be a student currently at The University of Iowa First Name * Last Name * Hawk ID * Student ID Number * Email * Phone * Hometown (City, State) * T-Shirt Size * - Select -Men's SmallMen's MediumMen's LargeMen's X-LargeMen's XX-LargeWomen's SmallWomen's MediumWomen's LargeWomen's X-LargeWomen's XX-Large Graduation Year * Major(s) * Minor(s) Certificate(s) College/Department Is team member earning an Iowa JPEC certificate? * - Select -YesNo Has team member taken any Iowa JPEC classes? * - Select -YesNo Team Member 2 Information First Name * Last Name * Hawk ID * Student ID Number * Email * Phone * Hometown (City, State) * T-Shirt Size * - Select -Men's SmallMen's MediumMen's LargeMen's X-LargeMen's XX-LargeWomen's SmallWomen's MediumWomen's LargeWomen's X-LargeWomen's XX-Large Graduation Year * Major(s) * Minor(s) Certificate(s) College/Department Is team member earning an Iowa JPEC certificate? * - Select -YesNo Has team member taken any Iowa JPEC classes? * - Select -YesNo Team Member 4 Information First Name * Last Name * Hawk ID * Student ID Number * Email * Phone * Hometown (City, State) * T-Shirt Size * - Select -Men's SmallMen's MediumMen's LargeMen's X-LargeMen's XX-LargeWomen's SmallWomen's MediumWomen's LargeWomen's X-LargeWomen's XX-Large Graduation Year * Major(s) * Minor(s) Certificate(s) College/Department Is team member earning an Iowa JPEC certificate? * - Select -YesNo Has team member taken any Iowa JPEC classes? * - Select -YesNo Team Member 3 Information First Name * Last Name * Hawk ID * Student ID Number * Email * Phone * Hometown (City, State) * T-Shirt Size * - Select -Men's SmallMen's MediumMen's LargeMen's X-LargeMen's XX-LargeWomen's SmallWomen's MediumWomen's LargeWomen's X-LargeWomen's XX-Large Graduation Year * Major(s) * Minor(s) Certificate(s) College/Department New textfield Is team member earning an Iowa JPEC certificate? * - Select -YesNo Has team member taken any Iowa JPEC classes? * - Select -YesNo Team Member 5 Information First Name * Last Name * Hawk ID * Student ID Number * Email * Phone * Hometown (City, State) * T-Shirt Size * - Select -Men's SmallMen's MediumMen's LargeMen's X-LargeMen's XX-LargeWomen's SmallWomen's MediumWomen's LargeWomen's X-LargeWomen's XX-Large Graduation Year * Major(s) * Minor(s) Certificate(s) College/Department Is team member earning an Iowa JPEC certificate? * - Select -YesNo Has team member taken any Iowa JPEC classes? * - Select -YesNo Company Information How did your team hear about the Founders Club? Faculty Staff Advisor Mentor Friend Event Website Social Media Check all that apply. Business Name: * Date of company's formation: Include a brief summary of your business idea: * Industry Type: * Advanced Manufacturing Advertising/Marketing Arts/Entertainment/Recreation Biotech/Medical Building/Construction Education Services Financial Services Food/Beverage/Hospitality IT/Software Manufacturing Non-Profit Professional/Business Services Retail/Online Retail Telecommunications Travel Vehicle Parts/Dealers/Services Other Check all that apply. Is your team committed to starting this business? * Yes No Is your team willing to provide status reports and meet with JPEC staff on a regular basis and attend events and workshops to help ensure your success? Yes No Current Business Address: Company Email Company Website: Social Media Information entered here will be used to help promote your company through Iowa JPEC's social media accounts. Company Facebook Page: Please leave blank if not applicable. Company Twitter Handle: Please leave blank if not applicable. Personal Twitter Handle: Please leave blank if not applicable. Company Instagram: Please leave blank if not applicable. Media Release BY TYPING MY NAME IN THE FIELD BELOW, I AM AGREEING THAT I AM AT LEAST 18 YEARS OF AGE, AND THAT I'VE READ, UNDERSTOOD, AND GIVEN PERMISSION FOR THE USE OF MY LIKENESS OUTLINED HERE: I hereby provide permission for the University of Iowa and John Pappajohn Entrepreneurial Center to use, reproduce, electronically publish and display my name and company name, photograph, and any information provided by me in all media including, but not limited to, newpapers, magazines, television, radio, and Internet websites for the purpose of promoting the John Pappajohn Entrepreneurial Center and the University of Iowa. I undertand that this media will be accessible throughout the world and that stories may be in written, video and electronic form. Digital Signature * 2+2