Entrepreneurship Excellence Intake Application V3

Entrepreneurship Excellence Intake Application

Connecting Black businesses with resources to expand and grow!
The Urban League of Metropolitan Seattle’s Entrepreneurship Excellence Program is designed to develop and expand your small business by providing technical assistance and access to a network of resources to support the growth and sustainability of your business.
Your Name*
Date*

MonthDayYear
Today's Date

Please review the following sections to complete your application.

Be sure to fill out all applicable and/or required fields!

Business Owner Information
Business Owner Information

Please fill out all applicable fields below.
Business Owner Name*

First NameLast Name
Business Owner Phone Number*

Area CodePhone Number
Business Owner Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Race/Ethnicity*
Gender*
Preferred Pronouns*
Educational Background*
Disability Status*
Military Status*
Does the business owner require an interpreter?*

YesNo
If yes, please specify which language:

Referral Source
Referral Source

Please fill out all applicable fields below.
How did you hear about ULMS entrepreneurship services?*

Google SearchWord of MouthULMS WebsiteULMS EventULMS StaffTaaleem Community CenterOther
Would you like to join the ULMS subscription list to hear more about Entrepreneurship Small Business opportunities?*

YesNo

Certification
Certification

Please fill out all applicable fields below.
I certify or declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. All information given is subject to verification with all applicable State or Federal government agencies.
Do you understand, acknowledge, and affirm the certification statement above?*

Yes

All finished?

Click the submit button below!
You are about to submit your Entrepreneurship Excellence Intake application. Please make sure that all of the appropriate fields have been completed before clicking the button below.

Thank you for your interest!
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