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Canaccord Genuity Advisory Program for Women Entrepreneurs Application Form

Applying is easy!  The application process takes about 10 minutes to complete provided you have the following information on hand.

Note: you must complete the application in one session.

Required items:

  • Applicant details (name, title, company name, phone, email)
  • Company details (address, year incorporated, website, description, industry)
  • Short and long-term business goals
  • References, including, name, title, company, phone, email

Optional items:

  • Headshot
  • Supplementary documents
  • Company financial information for most, second, and third most recently completed financial year.

Canaccord Genuity protects the privacy of personal information in accordance with applicable privacy legislation and its privacy policies. Subject to the Applicant Agreement, Canaccord Genuity will keep confidential all information provided by you in this Application Form.

Step 1 - Applicant information

Note: Headshot must be in colour and JPG format with a maximum file size of 3MB.

Step 2 - Company information

Industry *
Are you the founding CEO? *

Step 3 - Financial information

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Please provide financial data for the most recent, second most recent and third most recently completed financial year. You will be able to review a summary table on the next page before submitting the form.

Most recent
Second most recent
Third most recent

Step 4 - Financial information: Review Summary

Review data

If you need to make a correction, click on the Previous Step button at the bottom of this page.

 For the year ended:  Most recentSecond most recentThird most recent
Number of employees:
Income before taxes:
Total Assets:  
Total Equity:
Last equity raise / valuation:
How have you financed your business? Please check all that apply: *
Have you or your company been the subject of any investigation by a regulatory agency or governing or governmental body, any disciplinary action by any such agency or governing body, or any civil or criminal complaint? *

Step 5 - The Program

Have you participated in a formal mentoring or advisory program before? *
How did you hear about this Program? *


First reference

Second reference

Applicant Agreement

Use of photo, etc. — If I am selected for the Canaccord Genuity Advisory Program for Women Entrepreneurs (the “Program”), I hereby give Canaccord Genuity Corp. and its affiliates (“Canaccord Genuity”) and those acting on behalf of each of them, the non-exclusive and transferable right, but not obligation, to use, edit, publicize and reproduce freely my name, personal information (other than financial information) and likeness, including, but not limited to, biographical data, picture, portrait, photograph, film, videotape, recordings of my voice or any written statements that I provide in connection with the Program, including, but not limited to, creating a press release announcing my selection, the development and publication of marketing materials, promotional publications, media publications and coverage, videos and other materials, whether such items are intended for an internal or external audience. I agree that no compensation shall be due to me or any other person (including the company named in the Application Form (“my company”)) for such usage.

Disclosure and Use of Information — I understand that the information (including the financial information) and materials provided in this application by me or on my behalf will be used by Canaccord Genuity (i) in conjunction with the Program for purposes of evaluating my application; and/or (ii) for the purposes of discussing with Canaccord Genuity potential business opportunities, including opportunities with third parties. I consent to the use of such information for these purposes and hereby confirm and represent that I have obtained any and all authorizations, consents or waivers required for such uses.

Information/background checks — I acknowledge that, in connection with my participation in the Program, Canaccord Genuity and/or third parties acting on its behalf may seek information about me or my company to confirm or supplement information in this application by (i) researching publicly available sources (including, without limitation, information available on social media, or the internet generally, or in court or regulatory agency records) and/or (ii) verifying my educational background and/or (iii) speaking to my references. I authorize all persons, investigative agencies, educational institutions and references to provide Canaccord Genuity and/or third parties acting on its behalf any information concerning me and my company, my educational background and the financial background of me and my company.

Release — In consideration of my participation in the Program, on behalf of myself (and my heirs, executors and administrators) and my company (and all of its affiliates, successors or permitted assigns), I hereby release and forever discharge (i) Canaccord Genuity; (ii) the partners, employees, agents, shareholders, members, representatives, successors and assigns of each of Canaccord Genuity Corp. and its affiliates; and (iii) the external advisors from any and all liabilities, claims, actions, damages, costs or expenses of any nature arising out of or in any way connected with my participation in the Program including (without limitation) any information or materials submitted in connection with this application; any information/background checks conducted in connection with my participation in the Program; the use of my name, personal information and likeness; any events, ceremonies or promotional activities related to the Program and/or my participation in the Program; and the determinations of the independent panels of judges with respect to this application and/or my participation in the Program.

Limitation of liability — In no event will Canaccord Genuity or any of its subcontractors be liable to me (or my heirs, executors and administrators) or my company (or any of its affiliates, successors or permitted assigns) for any consequential, incidental, indirect, punitive, exemplary or special damages (including loss of profits, data, business or goodwill) in connection with the Program, whether or not liability is based on breach of contract, tort, strict liability, breach of warranty, failure of essential purpose or otherwise, and even if any of them is advised of the likelihood of such damages.

Disputes — This Agreement is governed by the laws of the Province of Ontario. Any controversy or claim arising out of or relating to my participation in the Program shall be submitted first to voluntary mediation and, if mediation is not successful, then to binding arbitration in Toronto, Ontario, conducted in accordance with the general Canadian Arbitration Association Rules for Arbitration as in effect on the date hereof. The arbitration panel shall have no power to award non-monetary or equitable relief of any sort or to award or impose a remedy that (i) is inconsistent with these terms and conditions or any other agreement relevant to the dispute, or (ii) could not be made or imposed by a court deciding the matter in the same jurisdiction. I expressly waive any right that I might otherwise have to obtain such relief in arbitration or in any other forum. The result of the arbitration shall be binding on the parties, and judgment on any arbitration award may be entered in any court having jurisdiction.

I have read the Application Form, the Website and this Agreement, understand their contents and represent that I am legally competent to sign this document on behalf of myself and my company and am not aware of any agreement with any other party that would conflict with the terms set forth herein. To the best of my knowledge, the information provided in the Application Form is true and complete.

By checking this box, you indicate that you agree to the terms listed above. *


If you would like to find out more about the Canaccord Genuity Advisory Program for Women Entrepreneurs, please get in touch.


Terms and conditions applicable to the program are outlined in the application form.
Information and program details contained herein are subject to change without notice.