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UPBI
COMMUNITY BOOTCAMP
For those in difficult circumstances trying to start or grow a business
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Your first name:
*
Your answer
Your last name:
*
Your answer
Email
*
Your answer
Best phone number to reach you;
*
Your answer
Your home address
*
Your answer
Are you currently in business or are you thinking about starting a business? (check one)
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Currently in business
Thinking about starting a business
Describe the business that you have or the idea for the one you want to start
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Your answer
Where do you most need help?
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Your answer
Are you committed to attending all six consecutive Saturdays of the Community Bootcamp for Entrepreneurs? (check one)
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Yes
No
Are you requesting consideration for a scholarship to waive all but $100 of the fee based on being economically disadvantaged? (check one)
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Yes
No
How did you Learn about this program?
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TV
Social Media
Center for Leadership and Entreprenuerial Studies Website
Search Engine
Community Partner Referral
Other:
Gender
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Male
Female
Other:
Age Range
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<20
20-30
30-40
40-50
50-60
60-70
>70
Other:
Ethnicity
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White or Caucasian
African American
American Indian or Alaska Native
Latino or Hispanic
Asian
African
Other:
Military Status
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Active Duty
Retired
Veteran
Other:
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