First Name *
Last Name *
Email Address *
Phone Number *
Gender * —Please choose an option—WomanManNon-binaryTwo-SpiritAnother gender identityPrefer not to say
Postal Code *
City / Town *
Province * Ontario
LinkedIn Profile *
Website / Portfolio
Do you self-identify as Black? * —Please choose an option—YesNoPrefer not to answer
Are you 18 years of age or older? * —Please choose an option—YesNo
Accessibility accommodations
Venture / Business Name *
Business Website
Industry / Sector *
Current Venture Stage * —Please choose an option—Idea / ConceptValidating the OpportunityPrototype / MVPEarly-stage BusinessGenerating RevenueExisting Business Developing a New AI-enabled Opportunity
Registered / Incorporated? * —Please choose an option—YesNoIn Progress
Year Established
Briefly describe your business or venture. *
What problem are you solving? *
Who is your target customer? *
How does, or could, AI contribute to your product, service or business model? *
What progress have you made so far?
Customer interviewsMarket researchPrototype/MVPPaying customersRevenuePilotPartnershipsFundingIPNone yet
Describe traction, validation or achievements to date.
Current Annual Revenue * —Please choose an option—Pre-revenueUnder $25,000$25,000–$99,999$100,000–$249,999$250,000–$499,999$500,000+Prefer not to disclose
Current Employees *
Current Contractors
Funding Raised to Date
Why do you want to participate in BAIVA? *
What are the three biggest challenges preventing your venture from progressing? *
What do you hope to accomplish by the end of BAIVA? *
Can you commit to Oct 2026 – July 2027? * —Please choose an option—YesNo
Can you participate virtually and in person in Southern Ontario? * —Please choose an option—YesNo
AI opportunity identificationCustomer / market validationAI technical developmentPrototype / MVP developmentProduct developmentBusiness strategyCommercializationGo-to-market strategyPricing / revenue modelFinancial modellingIntellectual propertyCybersecurity / data privacySales / customer acquisitionPartnerships / market accessFunding / investment readinessPitch developmentMentorship
Number of Founders / Co-founders *
Primary Business Location *
How did you hear about BAIVA? * —Please choose an option—BLACKTECHCommunity OrganizationEcosystem PartnerSocial MediaReferralEventOnline SearchOther
Preferred Communication * —Please choose an option—EmailPhoneBoth
I confirm that the information provided is accurate to the best of my knowledge and understand that submitting an application does not guarantee admission to BAIVA.
I consent to BLACKTECH collecting and using the information provided for program assessment, administration, monitoring, reporting and evaluation in accordance with applicable privacy requirements.