*1.Did you attend the virtual Info Session about this program that was offered June 25th?(Required.)

Yes

No

*2.Please provide the following information(Required.)

Your Name *

Company Name *

Address *

Address 2

City/Town *

ZIP/Postal Code

Email Address *

Phone Number *

*3.When was your company formed?(Required.)

202420232022202120202019201820172016Earlier than 2016

4.Is the company registered with the Virginia State Corporation Commission?

Yes

No

5.Is the company licensed through DPOR?

Yes

No

In Process

*6.What was the company's gross receipts in 2023?(Required.)

*7.Which of the following best describes your line of business within the construction industry?(Required.)

Construction Trade Contractor

General Contractor

Hauler

Janitorial / Construction Clean-Up

Other (please specify)

*8.This is a 10-week, in-person program beginning July 9th. The sessions will be held Tuesday evenings from 5:30 - 7:30 at a Chesterfield County Public Library (dinner will be provided). Participants are only allowed to miss one session. Are you able to commit to fulfilling the attendance requirements?(Required.)

Yes

No

Don't Know

9.Is it okay to share your contact information with other firms that have expressed an interest in this program?

Yes

No

10.Are there any comments you'd like to add about your company to help us in the decision process?