Question Title

* 1. First and Last Name

Question Title

* 2. Business Name (Established or Intended)

Question Title

* 3. Business Website

Question Title

* 4. Which program track would you be interested in joining?

Question Title

* 5. Are you able to make a commitment to dedicate at least one hour a week working one-on-one with your mentor for twelve weeks?

Question Title

* 6. What are you most interested in gaining/learning during this program?

Question Title

* 7. What areas do you believe your business is doing really well in?

Question Title

* 8. What areas of your business do you find the most challenging?

Question Title

* 9. What makes the Applegate a great place to own and run a business?

Question Title

* 10. What are the biggest challenges of running a business in the Applegate valley?

Question Title

* 11. Email (we will only contact you if you are selected)

Question Title

* 12. Phone Number (we will only contact you if you are selected)

Question Title

* 13. Thank you for your application! We look forward to selecting our first round of scholarship recipients for the EIR program by July 14th, and will reach out that same day! Please share this opportunity with other business owners you may know in the Applegate Valley!

T