The information you provide is confidential and will only be shared with your consent for the purposes of matching you with a Local Economy Incubator mentor or in a member-to-member skillshare.

Question Title

* 1. First and Last Name:

Question Title

* 2. How long have you been a Time Banker?

Question Title

* 3. How has Time Banking affected your life?

Question Title

* 4. Email:

Question Title

* 5. Phone:

Question Title

* 6. What is your gender?

Question Title

* 7. Languages spoken (please indicate level of proficiency):

Question Title

* 8. How did you hear about the Local Economy Incubator?

Question Title

* 9. Business name:

Question Title

* 10. Website:

Question Title

* 11. Type of business conducted:

Question Title

* 12. Please check one:

Question Title

* 13. Business model:

Question Title

* 14. Number of employees (full and part time, excluding owner):

Question Title

* 15. Location:

Question Title

* 16. Demographic served (who are your customers?):

Question Title

* 17. Years in operation:

Question Title

* 18. Years of experience in this field:

Question Title

* 19. Do you have a business license?

Question Title

* 20. Do you have a written business plan?

Question Title

* 21. Does your business have a social mission?

Question Title

* 22. Does your business promote environmental and/or community sustainability?

Question Title

* 23. Does your business support, participate in or promote the Sharing Economy?

Question Title

* 24. Skills Needed (please select all that apply):

Question Title

* 25. Have you tapped the social capital of the ASNTB community in your business thus far?

Question Title

* 26. Are you interested in applying for a community-supported ASECO micro-loan?

Question Title

* 27. What do you hope to achieve (the overall, big picture) with our help?

Question Title

* 28. Is there anything not covered on this application that you would like to know about the Local Economy Incubator?

T