Public Assistance to Entrepreneurship Application

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* 1. Please enter your contact information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. In which County do you currently live?

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* 3. Are you able to commit to two (2) half-day classes, two (2) times per week for a total of four (4) weeks?

Yes

No

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* 4. What type of business are you interested in starting?

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* 5. What are your personal and professional goals?

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* 6. Why are you interested in becoming self-employed?

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* 7. Do you have any experience in owning your own business? If your answer is "Yes", please briefly explain below.

Yes

No

Describe your experience owning your own
business if applicable.

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* 8. What skills do you have that will help make you successful in owning your own business?