Entrepreneurship Excellence Intake Application V4

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 Information
  
  Please complete all applicable fields below.
- Business Name*
- Business EIN# or Social Security #*
- Business Phone Number*
  
  Area CodePhone Number
- Business Email*
  example@example.com
- Business Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Do you currently have a Business License*
  
  YesNo
- Legal Entity Type*
  
  Limited Liability Company (LLC)Sole Proprietorship501(c)3PartnershipC CorporationS CorporationClosed CorporationNon-Profit OrganizationUnknownOther
- Industry
  
  What is your industry?
- Business & Commerce
- Lifestyle & Hospitality
- Industrial & Operations
- Social & Public Services
- Technology & Digital
- Other
  please specify
- Organization Type*
- Is your business currently operational?*
  
  YesNo
- How long has the business been established?*
  ex: 4 years
- Approximately when do you open your business?
  
  MonthDayYear
  Date
- Business Stage*
  
  Pre-VentureExistence / InfancyEarly Growth StageExpansion StageMature BusinessDecline to AnswerOther
- Which of the following MBE Certifications apply to your Business? Please select all that apply:
  
  Certified Women-ownedCertified Immigrant-ownedCertified LGBTQ+ ownedCertified Veteran-ownedCertified Refugee-ownedCertified Minority-ownedCertified Disadvantaged-ownedCertified Disabled-ownedCertified Service Disabled-owned
- Is your business Black-owned?*
  
  YesNo
- What other classifications align with your business? Please select all that apply:
  
  Women-ownedImmigrant-ownedLGBTQ+ ownedVeteran-ownedRefugee-ownedMinority-owned
- How Many employees do you have?
- Business Website (if applicable)
- What business services are of interest to you? Please select all that apply:
  
  Tax AssistanceWebsite DevelopmentCapacity BuildingContract ProcurementGrants & LoansMarketing & MediaBusiness DevelopmentFunding & Capitol ResourcesInformation Technology
- 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
- What is your ethnicity?*
  
  Hispanic or LatinoNot Hispanic or LatinoPrefer not to answerOther
- What is your race?*
  
  American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhitePrefer not to answerOther
- What is your nationality/cultural background? (e.g. Ethiopian, Somali, Nigerian, Indian, Mexican, Vietnamese, etc.)
- Race/Ethnicity*
- What is your gender?*
  
  FemaleMaleNon-binaryGender non-conformingPrefer not to answerOther
- Gender*
- What are your preferred pronouns?*
  
  She/Her/HersHe/Him/HisThey/Them/TheirsPrefer not to answerOther
- Preferred Pronouns*
- Educational Background*
- Disability Status*
- Military Status*
- Does the business owner require an interpreter?*
  
  YesNo
- If yes, please specify which language:
- 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
  
  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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Entrepreneurship Excellence Intake Application

Please review the following sections to complete your application.

Business Information

Industry

Business Owner Information

Referral Source

Certification

All finished?