Elevate Mentors Application Details

1. Personal Details

Registration Number:
Name of the applicant:
Designation:
Name of the entity/ company (As per registration):
Company Website:
Email 1 (Primary):
Email 2 (Secondary):
Mobile Number:
Address Line 1 (No, Street):
Address Line 2 (Block, Cross, Main, Stage):
City:
Pincode:
District:
State:

2. Company Details

Are you a registered startup by the Karnataka Startup Cell and have received the certificate of registration?:
Team Size:
Total No of Employees:
Is your startup promoted by a Women Entrepreneur? (Refer to the definition. You will have to furnish valid documents/ proofs at later stages):
Is your Startups promoted by SC/ ST Entrepreneurs? (Refer to the definition. You will have to furnish valid documents/ proofs at later stages):
Which stage is your startup in ?:
Are you incubated in GoK Supported incubators (Please choose one among the following):
Are you a part of any accelerator program ?:
Sector / Industry:
Technology Vertical 1 :
Technology Vertical 2 :
Please mention the Mentors or Advisors on your board:
Problem area sought for Mentoring:
Please state 4 questions of your choice based on the above area selected:

3. Declaration

Pitch Deck