Supplier Diversity Academy Application Form

Question Title

* 1. Applicant Contact & Company Information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. What is your product or service?

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* 3. How long have you been in business?

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* 4. What is your company's annual revenue?

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* 5. How many employees do you have?

Full-time Employees

Part-time Employees

Sub-contractors / 1099

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* 6. List any certifications you have:

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* 7. Does your company have Mission and Vision Statements? If so, please state either or both:

Mission

Vision

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* 8. Do you have a business plan?

Yes

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* 9. What are three (3) specific goals that you are trying to accomplish this year? List in order of priority:

Priority 1

Priority 2

Priority 3

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* 10. Any specific challenges you currently face?

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* 11. Have you ever requested a business loan?

Yes

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* 12. If you have requested a business loan, what was the amount?

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* 13. Was the loan approved?

Yes

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* 14. What are your anticipated capital financing needs within the next 24 months (briefly describe)?

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* 15. Are you a member of any business organizations? Please check all that apply:

Hispanic Chamber of Commerce of Metro Orlando

African American Chamber of Commerce of Central Florida

The Pride Chamber

Other (please specify)

Supplier Diversity Academy Application Form

Question Title

* 1. Applicant Contact & Company Information

Question Title

* 2. What is your product or service?

Question Title

* 3. How long have you been in business?

Question Title

* 4. What is your company's annual revenue?

Question Title

* 5. How many employees do you have?

Question Title

* 6. List any certifications you have:

Question Title

* 7. Does your company have Mission and Vision Statements? If so, please state either or both:

Question Title

* 8. Do you have a business plan?

Question Title

* 9. What are three (3) specific goals that you are trying to accomplish this year? List in order of priority:

Question Title

* 10. Any specific challenges you currently face?

Question Title

* 11. Have you ever requested a business loan?

Question Title

* 12. If you have requested a business loan, what was the amount?

Question Title

* 13. Was the loan approved?

Question Title

* 14. What are your anticipated capital financing needs within the next 24 months (briefly describe)?

Question Title

* 15. Are you a member of any business organizations? Please check all that apply:

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* 16. How did you hear about this program

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* 17. Do you have any additional information you would like to share?