Preferred name
Country of Birth Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belgium Belize Benin Bermuda Bermuda Bhutan Bolivia Bonaire, St Eustatius and Saba Bosnia and Herzegovina Botswana Brazil British Antarctic Territory British Indian Ocean Territory British Overseas Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Byelorussia Cambodia Cameroon Canada Canary Islands Cape Verde Islands Cayman Islands CaymanIslands Central African Republic Chad Channel Islands Chechoslavakia Chile China Christmas Island Cocos (Keeling) Islands Columbia Comoros Congo (Democratic Republic) Congo (Peoples Republic) Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Cyprus (European Union) Cyprus (Non-European Union) Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (Timor-Leste) Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French West Indies Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatamala Guernsey Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jersey Jordan Kazakhstan Kenya Kiribati Korea (South) Korea DRY (North) Kosovo Kuwait Kyrgyz Republic Kyrgyzstan Lao PDR Latvia Lebanon Leeward Islands Lesotho Liberia Libyan AR Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Islands Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldavia Monaco Mongolia Monserrat Montenegro Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Guinea New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Phillippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Ruanda Russian Federation San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Somalia Somaliland South Africa South Georgia and South Sandwich Islands South Sudan Spain Sri Lanka St Helena St Kitts-Nevis St Lucia St Pierre And Miquelon St Vincent Stateless Sudan Surinam Svalbard And Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikstan Tanzania Thailand Togo Tokelau Tongo Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uraguay US Trust Territories USSR Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (US) Wales Wallis & Futuna West Indies Western Sahara Western Samoa Windward Islands Yemen Yemen Arab Republic Zambia Zimbabwe
Nationality Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgian Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Brazil British British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Burma Burundi Cambodia Cameroon Canada Cape Verde Islands Cayman Islands Central African Republic Chad Channel Islands Chile China Columbia Comoros Congo Congo (Democratic Republic) Costa Rica Croatia Cuba Curaçao Curaçao Cypriot (Non-European Union) Cyprus (European Union) Czech Czechoslovakia Denmark Djibouti Dominica Dominican Republic East Timor (Timor Leste) Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands, Greenland Fiji Finland France Gabon Gambia, The Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guernsey Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong (Special Administrative Region of China) Hungary Iceland Indian Indonesia Iran (Iran, Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Ivory Coast (Cote d'Ivorie) Jamaica Japan Jersey, Channel Islands Jordan Kazakhstan Kenya Kiribati Korea (North) (Korea, Democratic People's Repubic of) Korea (South) (Korea, Republic of) Kosovan Kuwait Kyrgyzstan Laos People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao (Special Administrative Region of China) Macedonia (The Former Yugoslav Republic of) Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexican Micronesia (Federated States of) Moldova (Moldovia, Republic of) Monaco Mongolia Monserrat Montenegro Montenegro Morocco Mozambique Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Northern Ireland Northern Mariana Islands Norway Not known Not Known Occupied Palestinian Territories Oman Pakistan Palaua Panama Papula New Guinea Paraguay Peoples Democratic Republic of Yemen Peru Phillippines Pitcairn, Henderson, Ducie and Oeno Islands Poland Portugal Qatar Romanian Russian Federation Rwanda Samoa San Marino Sao Tome and Principle Saudi Arabia Scotland Senegal Serbia Serbia & Montenegro Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka St Helena, Ascension and Tristan da Cunha St Kitts and Nevis St Lucia St Vincent and the Grenadines Stateless Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan (Taiwan, Province of China) Tajikistan Tanzania, (Tanzania, United Republic of) Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Tuvalu Uganda UK National Ukraine Union of Soviet Socialist Republic United Arab Emirates United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela, Bolivarian Republic of Vietnam Wales Western Sahara Yemen Yugoslavia Zambia Zimbabwe
Country of Residence for Last 3 Years Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belgium Belize Benin Bermuda Bermuda Bhutan Bolivia Bonaire, St Eustatius and Saba Bosnia and Herzegovina Botswana Brazil British Antarctic Territory British Indian Ocean Territory British Overseas Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Byelorussia Cambodia Cameroon Canada Canary Islands Cape Verde Islands Cayman Islands CaymanIslands Central African Republic Chad Channel Islands Chechoslavakia Chile China Christmas Island Cocos (Keeling) Islands Columbia Comoros Congo (Democratic Republic) Congo (Peoples Republic) Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Cyprus (European Union) Cyprus (Non-European Union) Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (Timor-Leste) Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French West Indies Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatamala Guernsey Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jersey Jordan Kazakhstan Kenya Kiribati Korea (South) Korea DRY (North) Kosovo Kuwait Kyrgyz Republic Kyrgyzstan Lao PDR Latvia Lebanon Leeward Islands Lesotho Liberia Libyan AR Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Islands Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldavia Monaco Mongolia Monserrat Montenegro Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Guinea New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Phillippines Pitcairn Island Poland Portugal Puerto Rico Qatar Reunion Romania Ruanda Russian Federation San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Somalia Somaliland South Africa South Georgia and South Sandwich Islands South Sudan Spain Sri Lanka St Helena St Kitts-Nevis St Lucia St Pierre And Miquelon St Vincent Stateless Sudan Surinam Svalbard And Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikstan Tanzania Thailand Togo Tokelau Tongo Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uraguay US Trust Territories USSR Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (US) Wales Wallis & Futuna West Indies Western Sahara Western Samoa Windward Islands Yemen Yemen Arab Republic Zambia Zimbabwe
How did you find out about Launchpad? *
Tell us a little about your desire to start a new company. *
How do you think Launchpad will help you on your start-up journey? *
If your application doesn't succeed, what will you do instead? *
Gender * Female Male Other / Prefer Not To Say
Ethnic Background * Arab Asian - Bangladeshi Asian - Chinese Asian - Indian Asian - Other Asian - Pakistani Black - African Black - Caribbean Black - Other Gypsy or Traveller Rather not say Irish Traveller Not Known Other Other Mixed White White and Asian White/Black African White/Black Caribbean
Disability * No disability Autistic disorder Blind/Partial sight Deaf/partial hearing Learning difficulty (DYSLEXIA/AD(H)D) Long standing illness Mental health Multiple disabilities Other disability Wheelchair/mobility
Have you ever been in care? * Prefer Not To Say Yes No
Do your parents/guardians have any higher education qualifications such as a degree, diploma or certificate of higher education? * Prefer Not To Say Yes No Don't Know