Creative Entrepreneur Accelerator Program Referral Form Survey

1.Referral Coordinator Agency/Organization(Required.)

2.Applicant Information(Required.)

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

3.Eligibility Information - all must be satisfied for referral(Required.)

Client is at least 18 years of age and has been a resident of Pennsylvania for at least
twelve months prior to referral.

Client is a creative entrepreneur operating or intending to form an eligible creative
business as defined in the Creative Entrepreneur Accelerator Program guidelines.

If the client operates an eligible creative business, the business had gross revenue of less
than$200,000 for the period covered by the business’ most recently submitted annual filing
to the Internal Revenue Service.

Client has completed at least one consultation session with Referral Coordinator.

4.Review Checklist (Required.)

Client has a viable business plan or clear plan to execute business.

5.Business plan clearly demonstrates:(Required.)

Understanding of product or services

Understanding of target consumer or audience

Plan to reach target audience or consumer

Clear budget for one year of operation

Goals, benchmarks, and metrics to evaluate success

Proposed grant-supported activities will help grow audience/revenues

The proposed use of grant funds is appropriate

6.E-Signature of Referral Partner(Required.)

7.Date Submitted(Required.)

Date / Time

Date

SuSunday

MoMonday

TuTuesday

WeWednesday

ThThursday

FrFriday

SaSaturday

Creative Entrepreneur Accelerator Program Referral Form

Region 13 - Armstrong, Butler, Clarion, Indiana, & Jefferson Counties