Rock County Jumpstart Membership Application
We anticipate launching in Spring or Summer 2020. Are you interested in joining the Rock County Jumpstart community? Please complete the application below.
Email address *
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Phone Number (Include Area Code) *
Your answer
Do you currently own a business? *
Is your business located in Rock County? *
Is your business more than 51% owned AND operated by a person who identifies as Black/African American? *
What is the name of your business? *
Your answer
What type of goods/services does your business sell? *
Your answer
How long has your business been in operation? *
Please provide a link to your website or Facebook Page *
Your answer
Where do you run your business? *
What is the biggest challenge you have running your business? (Choose up to three answers) *
Required
Do you any additional comments or questions?
Your answer
A copy of your responses will be emailed to the address you provided.
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