Self-Employment Training Series Application
The Center for Human Development is offering a free six week online class in marketing and networking for Artists and Crafters who are low income and experience a disability. This training series is offered for free because it is part of a research study that is funded in part through a Cooperative Agreement with the U.S. Small Business Administration. You will be asked to consent to the research, complete surveys, and provide information about your business.
Sign in to Google to save your progress. Learn more
Participant Information
Name *
I prefer to be called...
Gender *
Date of Birth *
Do you experience a disability? *
Address *
City *
State *
Zip Code *
How did you hear about this opportunity?
Certification of Household Size and Income
I certify that the number of persons in my household is... *
I certify that my total income for the past year (12 months) did not exceed... *
Approximately how much money did you make in the past year?
Business Information
Have you been selling any goods or services on an on-going basis?
Clear selection
If yes, please describe?
Do you own a small business? *
Business description *
What stage are you in your business? *
If established, how long? If re-establishing, how long were you in business previously?
Technology
Your responses to the following questions will not affect your ability to participate in this workshop series. We are asking these questions so we have a better understanding of your needs.
Do you have access to a computer with an internet connection? *
It is best to have a headset with speakers and a microphone to participate in the online sessions. We have some headsets available through this project. Do you need a headset?
Clear selection
Have you used web conferencing systems, like Elive or  WebEx, before? *
Do you use or require any of the following?
Check all that apply.
Contact Information
Primary phone *
Secondary phone
E-mail address *
The best way to contact me is... *
Required
The best time to contact me by phone is...
Electronic Submission
By submitting this form you confirm that all the information is correct to the best of your knowledge.
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
This form was created inside of UAA Center for Human Development.