Be part of AZ Navigator 2.0!🚀

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Thank you for your interest in AZ Navigator 1-on-1 consulting! The purpose of this questionnaire is to collect information that will allow us to personalize our technical assistance and ensure that you receive the support necessary for the growth and success of your business. The information provided will be treated with strict confidentiality and used only to improve the services we offer.

Date:
*

YYYY

Gender:
*

Male

Female

Non-binary

Prefer not to say

Race & Ethnicity:
*

African American

Asian

Caucasian

Hispanic/Latino

Native American

Other:

Disability Status:
*

Yes

Prefer not to say

LGBTQ Status:
*

Yes

Prefer not to say

Veteran Status:
*

Yes

Full Name:

Business Name:
*

Telephone Number:
*

County: *

Email Address:

Has the applicant (individual or organization) previously participated in this program?
*

Yes

Has the applicant (individual or organization) been negatively impacted by the effects of the COVID-19 Pandemic?
*

Yes

What type of Business Technical Assistance are you requesting?
*

Business Model Canvas/ Lienzo de Modelo de Negocio

LLC Formation / Formación de Compañía de Responsabilidad Limitada

Industry-specific or General Coaching / Mentoria general o específica a la industria

Social Media Coaching / Asesoria para Redes Sociales

Required

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