Company Name *
Your answer
Name *
Your answer
Title *
Your answer
Business Street Address *
Your answer
City *
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
At what email address would you like to be contacted? *
Your answer
Are you the CEO, business owner or decision maker for your company? *
Business Website
Your answer
Please enter your Federal Employer Identification Number *
9 digit FEIN (XX-XXXXXXX)
Your answer
How did you hear about the program? *
Your answer
Please indicate all of the areas you are interested in *
Required
As a condition of acceptance into the Nevada Grow Program, I commit to the following: *
Required
Under the condition that all company indentifying information is removed, do we have your permission to use this data? *
Please best describe the industry of your business *
e.g. Transportation, Healthcare, Manufacturing, etc.
Your answer
What benefit is your business to the market? What market deficiency does your business provide a solution for? Who is your target market? *
Your answer
Is your company privately owned and operated? *
Business Legal Form *
When was your company founded? *
MM
/
DD
/
YYYY
Please describe your expectation for assistance *
Your answer
Please select the markets where you sell your products or services *
Select all that apply.
Required
Please enter the current number of full-time W-2 employees *
Your answer
Please enter the current number of part-time W-2 employees *
Your answer
Please enter the current number of full-time 1099 employees *
Your answer
Please enter the current number of part-time 1099 employees *
Your answer
Please enter your end of year revenue for your most recent fiscal year. *
Your answer
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. *
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