Workshop in Business Opportunities (WIBO) Application

Thank you for your interest in LifeBridge Community Service's WIBO Program. Please allow 30-45 minutes to complete this online application for consideration into our 16-week entrepreneurial workshop. After submitting your application, a representative from our Small Business Development team will be in contact to schedule a brief exploratory conversation. This conversation be about you and your business goals to discover what is best for your business and how we can help you create a brighter future!

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* 1. First Name

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* 2. Last Name

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* 3. Phone Number (Please enter XXX-XXX-XXXX)

Home Phone

Cell Phone

Work Phone

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* 4. E-mail Address

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* 5. I am interested in the

Tuesday Evening Class (6pm - 9pm)

Wednesday Morning Class (10am - 1pm)

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* 6. Gender

Male

Female

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* 7. Age

Under 25

26 - 35

36 - 49

50 - 65

Over 65

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* 8. Education Level (Please indicate the highest level of education you have achieved.)

Less than a high school education

High School or GED

Vocational School

Some college but did not receive a degree

Associates Degree (2Yr Degree)

Bachelors Degree (4Yr Degree)

Masters Degree

Doctoral Degree

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* 9. Military Service

Veteran/Active Duty or Reserves

Never serviced in the military

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* 10. Current Employment Status

Working Full Time

Working Part Time

Retired

Full Time Student

Unemployed - Less than 6 months

Unemployed - More than 6 months

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* 11. Ethnicity

Latino

Native American

Black / African American / Caribbean

Asian

White

Multi-racial

Other (please specify)

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* 12. Current annual household income

$0 - $10,000

$10,000 - $35,000

$35,000 - $50,000

$50,000 - $75,000

$75,000 - $100,000

$100,000 +

Workshop in Business Opportunities (WIBO) Application - Fall 2017

Basic Information

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* 1. First Name

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* 2. Last Name

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* 3. Phone Number (Please enter XXX-XXX-XXXX)

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* 4. E-mail Address

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* 5. I am interested in the

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* 6. Gender

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* 7. Age

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* 8. Education Level (Please indicate the highest level of education you have achieved.)

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* 9. Military Service

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* 10. Current Employment Status

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* 11. Ethnicity

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* 12. Current annual household income