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* 1. What is your name?

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* 2. What is your street address?

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* 3. What is your phone number?

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* 4. What is your birth date?

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* 5. What is your email address?

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* 6. What is the name of your business?

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* 7. How long have you been running your business?

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* 8. How is your business set up?

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* 9. Do you have everything set up to pay sales taxes, quarterly payments, etc?

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* 10. What products are you making?

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* 11. What aspect of running a business do you need help with?

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* 12. Do you have any of the following for your business?

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* 13. We are looking at meeting monthly as a group. What day works better for you?

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* 14. If coming to in person meetings will you need childcare?

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* 15. What are the names and ages of your child(ren)

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* 16. As a JOBS Participant in the "SHEro Shakers" we are getting entrepreneur women to be mentors! Are you willing to work with a mentor?

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* 17. Are you willing to work with the Financial Empowerment Center to help with business finances?

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* 18. Did a agency or organization refer you? If yes, list who. If no, list how you heard about JOBS.

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