Register You’re about to start Fase1! Complete the form and you will be closer to the starting point. "* Required fields" indicates required fields ¡Estás a punto de comenzar en Fase 1! Completa el formulario y estarás más cerca del punto de partida. Nombre* Required fields Nombre Apellido Email* Required fields Teléfono* Required fieldsSeguro Social* Required fields Are you a resident of Puerto Rico?* Required fields Yes No Are you a US citizen or permanent resident?* Required fields Yes No Address* Required fields Address line 1 Address line 2 City State Zip Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Mailing address* Required fields Dirección línea 1 Dirección línea 2 City Estado Código postal CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands País Employment status* Required fields Employed Not Employed Education level* Required fields Completed College Completed High School Some College Some High School Do you need help to develop your business idea?* Required fields Yes No Do you have an established business?* Required fields Yes No Developing Founder or team leader background* Required fieldsCantidad de dueñosPlease enter a number from 1 to 5.Información sobre dueñosNombrePorciento de propiedad Add RemoveCantidad de empleados, incluyendo a los dueñosHave you received any financial assistance for your business or business idea in the past?* Required fields Yes No Favor incluye si la ayuda recibida fue para un pequeño negocio.* Required fieldsIndicar la cantidad otorgada* Required fieldsIncluya el nombre de la entidad, agencia u organización que proveyó los fondos.* Required fields Indicate the status of the head of your household* Required fields Single Head of Household - Female Single Head of Household - Male Not a Single Head of Household Prefer not to answer Family annual income (all household income)Indicate the number of people living in your household* Required fieldsWhen selecting the number of people living in your household, look at the box below to select your income level. 1 2 3 4 5 6 7 8 The family annual income of my household is: Below $28,140 Above $28,140 The family annual income of my household is: Below $32,160 Above $32,160 The family annual income of my household is: Below $36,180 Above $36,180 The family annual income of my household is: Below $40,200 Above $40,200 The family annual income of my household is: Below $43,416 Above $43,416 The family annual income of my household is: Below $46,632 Above $46,632 The family annual income of my household is: Below $49,848 Above $49,848 The family annual income of my household is: Below $53,064 Above $53,064 Select the category that best represents you according to your race and ethnic group* Required fields American Indian/Alaskan Native Asian Black/African American Native Hawaiian/Other Pacific Islander White Indian/Alaskan Native & White Asian & White Black/African American & White Hispanic - American Indian/Alaskan Native Non-Hispanic Hispanic Hispanic - Asian Non-Hispanic Hispanic Hispanic - Black/African American Non-Hispanic Hispanic Hispanic - Native Hawaiian/Other Pacific Islander Non-Hispanic Hispanic Hispanic - White Non-Hispanic Hispanic Hispanic - Indian/Alaskan Native & White Non-Hispanic Hispanic Hispanic - Asian & White Non-Hispanic Hispanic Hispanic - Black/African American & White Non-Hispanic Hispanic You identify yourself as:* Required fields Gen.Z (born between 1995-2012) Millennial (born between 1981-1994) Gen.X (born between 1965-1980) Baby Boomer (born between 1946-1964) Why are you interested in Fase1?* Required fieldsYou can choose more than one I want to learn about entrepreneurship I want to use my skills and experiences in another field I want to take my college project to a business I want to learn how to validate my business idea I want to add innovation to my business What is your salary range?* Required fields Below $20,000 $20,000 to $44,999 $45,000 to $59,999 $60,000 to $74,999 $75,000 or more Schooling level* Required fields High School Bachelor’s degree Master’s degree Doctor’s degree Other Schooling level - Other Languages you dominate* Required fieldsYou can choose more than one Spanish written and spoken Spanish written Spanish spoken English written and spoken English written English spoken Other Languages you dominate - Other How would you catalogue your technology knowledge?* Required fields Basic Intermediate Advanced How did you hear about Fase1?* Required fields Social Media Print Media TV Radio Colmena66 referral Other How did you hear about Fase1 - Other Our purpose is to ensure that we’re being inclusive with our marketing and recruiting efforts.You identify yourself as: Asexual Bisexual Gay Heterosexual Lesbian Pansexual Transgender Queer Prefer not to answer Choose your pronouns: She He They/them Prefer not to answer CAPTCHAI understand that including my name in the box below is equivalent to accepting and signing this form.Full Name* Required fields Date* Required fields MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.
