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Company Name *

Name *

Title *

Business Street Address *

City *

Las Vegas

Henderson

North Las Vegas

Other:

State *

Zip Code *

Phone Number *

At what email address would you like to be contacted? *

Are you the CEO, business owner or decision maker for your company? *

Yes

Business Website

Please enter your Federal Employer Identification Number *

9 digit FEIN (XX-XXXXXXX)

How did you hear about the program? *

Please indicate all of the areas you are interested in *

Expansion of Business

Peer 2 Peer Mentoring

Employee Training

Data Collection and Mining

Marketing Techniques

Identification of Target Markets

Access to Financing/Capital

Advocacy

Finance/Business Skills Training

Budgeting

Setting Benchmarks for Success

Other:

Required

As a condition of acceptance into the Nevada Grow Program, I commit to the following: *

I will be available for periodic check-in calls.

I will be available for a Close-out call at the end of the engagement.

I will take primary responsibility and be the lead from my organization on each call. Other senior managers may be involved as well, but they must be involved in the entire process.

I will be available to the Team Leader and specialists throughout the engagement to review work and participate as needed.

I will complete a short close-out survey at the end of the engagement evaluating the work and the individuals on the team.

Required

Under the condition that all company indentifying information is removed, do we have your permission to use this data? *

Yes

Please best describe the industry of your business *

e.g. Transportation, Healthcare, Manufacturing, etc.

What benefit is your business to the market? What market deficiency does your business provide a solution for? Who is your target market? *

Is your company privately owned and operated? *

Yes

Business Legal Form *

Sole Proprietorship

Partnership

Corporation

Limited Liability Corporation (LLC)

S Corporation

When was your company founded? *

YYYY

Please describe your expectation for assistance *

Please select the markets where you sell your products or services *

Select all that apply.

Local

Multiple Counties/Cities in Nevada

Nevada Statewide

Southwest United States

Nationally

Internationally

Other:

Required

Please enter the current number of full-time W-2 employees *

Please enter the current number of part-time W-2 employees *

Please enter the current number of full-time 1099 employees *

Please enter the current number of part-time 1099 employees *

Please enter your end of year revenue for your most recent fiscal year. *

Terms and Conditions

Pursuant to the Nevada Grow Act, for a business to be selected for this Program they must have obtained the following milestones prior to application submission:

(a) Have its principal place of business within the State of Nevada and have had its principal place of business in this State for at least 2 years;
(b) Generate at least $50,000 but not more than $700,000 in revenue; and
(c) Have a business plan.

On behalf of the Applicant, I hereby authorize the College of Southern Nevada (CSN) to collect, review, and report any needed information about my business pursuant to the Nevada Grow Program, established by the Nevada Grow Act. I further agree to hold CSN harmless for all activities associated with this program.

I certify that all information provided in this application is accurate and truthful. *

Yes

Submit

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