Indigenous LaunchPad Intake Form

Indigenous LaunchPad Intake Form

Mohawk Medbuy (MMC) is proud to establish the Indigenous LaunchPad to further support Indigenous Reconciliation and foster new relationships with Indigenous businesses. For more information abour our Indigenous LaunchPad and its benefits, please visit MMC's Website.

Indigenous businesses can apply to MMC’s Indigenous LaunchPad by submitting the detailed information below. If you’re an MMC Member or supplier, please encourage Indigenous businesses that may benefit from our Indigenous LaunchPad to apply directly through this form.

This information will be reviewed by our team internally and the listed organization(s) will be contacted should an opportunity be identified.

Organization Contact Information

Company Name*

Company Size*

0-100 Employees

101-500 Employees

501+ Employees

Company Contact First Name*

Company Contact Last Name*

Company Mailing Address: Street*

Company Mailing Address: City*

Company Mailing Address: Province*

Company Mailing Address: Postal Code*

Phone Number*

E-Mail*

How did you hear about the Indigenous LaunchPad?

Indigenous Self-Identification

This information is used to ensure the proposed company meets the definition of an Indigenous Business.

An Indigenous Business is defined as: a business, including sole proprietorships, limited companies, co-operatives, partnerships and not-for-profit organizations, that has at least 51% majority of the business owned and controlled by self-identifying Indigenous Peoples. Further, the definition of Indigenous Business includes businesses where at least one third of all full-time employees being Indigenous for businesses with six or more full-time employees.

Does this company meet the above defined criteria for being classified as an Indigenous business?*

Yes

In an effort to understand and promote the unique Indigenous heritage of this business, please identify Indigenous, Inuit and / or Métis company ownership:

Non-Status

First Nation

Métis

Inuit

Please let us know what Community you are from

Please specify the % Indigenous Ownership of the Company

Is this company listed as a Certified Aboriginal Business on the Canadian Council for Aboriginal Business (CCAB)?

Yes

Is this company listed on the Federal Indigenous Business directory?

Yes

Please list any other designations you would like us to know about

Company Profile

Please tell us more about your company’s Indigenous ownership

For example, how the owner started the company, how Indigenous ownership was achieved, etc.

Please briefly describe your company history, milestones and memorable achievements

Please briefly describe the company business stream(s)

Product/ Service Details

What Service(s) or Product(s) does this organization offer?*

Is the product or service currently offered on contract through MMC?*

Yes

If Yes, please provide the contract no.

Does your company provide Canada-wide service?*

Yes

If no, please specify where your company service(s) or product(s) are able to be offered

Company Website URL

Is there anything else you would like us to know? Please enter it here.

File Upload

Please attach the following:

• CCAB and / or Federal Indigenous Business Directory Designation

• High-resolution company logo (EPS, JPG, PNG or TIFF format)

• Any other pertinent information about the company

• Clinical product information, if applicable (including medical licenses, standards, product testing results and / or product specification sheets)

Drag and drop files here or

Send me a copy of my responses

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