Client Intake Form (Needs Assessment) - Entrepreneurship Center @CTI
Si necesitas asistencia en español, llena este formulario: https://bit.ly/2VKGUkh

Use this form to communicate with the Entrepreneurship Center @CTI regarding your needs as our shared Covid-19 journey continues. Please fill this form to help us better assess your current needs. The form will provide a response, which includes the Daily Zoom Conference ID. You will also receive an email the morning after you complete this form, with additional information. You can use the same Zoom conference ID to join our daily zoom calls anytime.

We are on Zoom daily at 2:30 to answer all your general questions regarding COVID-19 emergency support, SBA Microloans, Acre Catalyst Fund, and virtual business coaching.

Funding:
If you are interested in applying for an SBA Microloan or Acre Catalyst Fund loan, please complete this form: https://forms.gle/wLEXFKmq8PKzDfMR8

Virtual Business Coaching:
If you are interested in virtual business coaching , that will enable you to succeed, post-COVID-19, please complete this form: https://forms.gle/aQWaz2Zw23FEXG5q6

We offer assistance in English and Spanish

Email address *
First Name *
Last Name *
Business Name *
Business Phone *
Business Email *
Cell Phone (relieve texts) (xxx) xxx-xxxx *
Preferred Contact Method *
Required
Business Address *
Business Zip Code *
Website (or intended if not purchased yet) *
Business Facebook (or intended if not purchased yet) *
Business Instagram (or intended if not purchased yet) *
How long have you owned your business? *
Do you have a completed business plan? *
Do you have completed Cash Flow Projections? *
How many employees do you have?
Clear selection
How much revenue did your business generate last year?
Clear selection
Choose the answer that best describes where you are in your journey
Clear selection
How productive are you on a weekly basis?
Clear selection
Choose the one that best first your current situation:
Clear selection
When it comes to bringing in new business how would you describe your marketing approach?
Clear selection
Choose the one that best fits your work/life balance?
Clear selection
Do you have a clear company vision?
Clear selection
Would you like more information about the SBA microloan debt relief program. (The SBA will pay your first six months of payments/interest and fees. This applies to existing and new microloans).
Clear selection
Do you describe yourself as an immigrant to the U.S.? *
Required
Are you veteran? *
Required
What is your ethnicity *
Required
What is your income range (before COVID-19) - based on a single household income. *
Required
How did you hear about us? *
Please tell us, in your words, how we can support you achieve your business goals? *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy