1.First and Last Name

2.Business Name (Established or Intended)

3.Business Website

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

Agriculture/Foods/Wine with Don Tipping

Arts/Entertainment with Colene Milligan

I'm Not Sure

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?

Yes

No

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

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

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

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

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

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

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

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!

Will Do!

OK!