1. Section 1

With generous support from the US Small Business Administration, OMEN is offering a range of services to help organizations build their capacity and increase service to entrepreneurs statewide. Participating organizations are offered the following menu of services from which to build their unique service delivery platform. In exchange for services, participating organizations will report on benchmarks to OMEN on a quarterly basis through September 30th, 2010. Please complete the contact information and select which services are of interest to your organization below by December 11, 2009.

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* 1. CAPACITY BUILDING (please check programs your organization would like to participate in)

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* 2. DIRECT SERVICES FOR MODERATE OR LOW-INCOME ENTREPRENEURS (please check programs your organization would like to participate in)

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* 3. Contact Information

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* 4. Organization Info

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* 5. What are your goals for participating in this program? (i.e. serve more clients, improve program outcomes, expand territory or services offered, etc.)

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* 6. Participating organizations commit to quarterly reporting to OMEN during the project year. We track program progress on a quarterly basis through September 30, 2010. Organizations participating in this program will be required to report on those benchmarks. Upon completion of this survey, OMEN will contact you.

I understand that my organization will work with OMEN to build a customized program to optimize my organization's services to disadvantaged entrepreneurs. I agree to comply with all reporting requirements in a timely manner in order to receive such services. (Please type your name below).

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