Public Assistance to Entrepreneurship Application Survey

1.Please enter your contact information(Required.)

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

2.In which County do you currently live?

3.Are you able to commit to two (2) half-day classes, two (2) times per week for a total of four (4) weeks?(Required.)

Yes

No

4.What type of business are you interested in starting?(Required.)

5.What are your personal and professional goals?(Required.)

6.Why are you interested in becoming self-employed?(Required.)

7.Do you have any experience in owning your own business? If your answer is "Yes", please briefly explain below.

Yes

No

Describe your experience owning your own
business if applicable.

8.What skills do you have that will help make you successful in owning your own business?