NextGen: Supplier Diversity Program

Emerging Young Entrepreneurs Program Interest Form

Home / NextGen Apply

Applicant Information

First Name *

Last Name

Job title *

Date of birth *

Email *

Phone number *

Ethnicity *African American/BlackAsian IndianAsian Pacific AmericanCaucasianHispanicNative American

Business Information

Company name *

Website URL *

Business DescriptionPlease provide a brief description of the goods/ and or services offered by your business.

Street address *

Street address 2

City *

State/Region *

Postal code *

Year Company Formed *

Number of employees *(including yourself)

Select Industry * *

Sales for 2022 *

Sales for 2021 *

Certification TypesMBEWBELGBTBEDOBECertified previously but have not been certified in the last 12 months

Current CustomersPlease provide a listing of current customers.

Current Business Plan

No file chosen

Please upload your business plan. It does not need to be long (3-5 pages max - Word or PDF).

What are your current business challenges?

What are your current business development objectives?

What resources are you currently engaging/using to scale your business?

What are you expecting to gain from your participation?

Signature

Each application is reviewed by the NextGen Supplier Diversity
programs team to ensure a diverse industry, geographical, and ethnic mix. Application submission does not guarantee placement in the program.

It is expected that participants will be free of other duties and will devote themselves fully to the program.

I have read the above and agree to the terms.

Signature of Applicant *(Please type your full name in the box below as your signature.)

Please Select *

Contact Us

+1 (631) 246-3026
info@minoritymillennials.org

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