subject_line
DCED Small Business Resources Interest Form
First Name
*
Last Name
*
Home Address
*
City
*
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Best number for us to contact you
*
Phone (Work)
Phone (Cell)
Phone Number
*
Mobile Phone
*
Best time to contact
*
Morning
Afternoon
Evening
Email Address
Date of Birth
*
+
Current Small Business Program Interest
Community Navigator Grant Program - Advising & Start.Pivot.Grow
Quickbooks Class - Future
How did you hear about us?
*
Builders of Hope
Forest Forward
Cornerstone
Golden Seeds
St. Philips
Other
Please Specify:
Business Profile Information
Company Name
(If none, enter "N/A")
*
Role/Title:
CEO
President
Owner
Director
Manager
Vice President
CMO
CFO
Project Manager
Other:
Other
Owner?
Yes
No
Same as home address
Business Street Address
Business City
Business State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Business Zip Code
Work Phone Number
Work Email Address
What stage is your business?
Idea (not yet formed)
Start Up (in business 1-2 years)
Build Stage (3-10 years)
Growth Stage (11+ years)
High Growth/Expansion
Maturity
Year Founded
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
What is the current Legal Structure?
Not Yet Formed
Sole Proprietorship
General Partnership
Limited Liability Partnership
Limited Liability Company
Corporation
S-Corporation
B-Corporation
Tax-Exempt Nonprofit Corporation
In which state is your company legally structured?
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Industry
Advertising & Marketing
Aerospace & Defense
Agriculture
Apparel
Architecture
Arts & Entertainment
Automotive
Banking
Beauty & Cosmetics
Biotechnology
Communications
Construction
Design & Printing
Education
Engineering
Environmental
Fashion
Financial Services
Fitness
Food & Beverage
Government Contracting
Healthcare & Medical Services
Home Goods
Hospitality
Human Resources & Staffing
Information Technology
Insurance
Legal
Logistics & Shipping
Manufacturing
Media & Video Production
Nonprofit
Pet Care & Services
Professional, Scientific & Consulting
Public Safety & Security
Real Estate
Retail
Scientific & Technical Services
Sports & Recreation
Technology
Telecommunications
Trade & Custodial Services
Transportation/Logistics
Travel
Government
Number of Full Time Employees
What do you currently sell?
Products
Services
Products and Services
Business Assessment Information
The following information is needed to help your business advisor prepare for your initial session and support you and your business goals.
Have you worked with a business consultant/advisor/coach before?
*
Yes
No
What is your year-to-date revenue?
*
Does your business have any of the following certifications?
8(a) Small Business Disadvantaged Business Program
8(m) Women's Contracting Rule Program
ACDBE - Airport Concessionaire Disadvantaged Enterprise Certification
B Corp Certification
DBE Disadvantaged Business Enterprise
DBE Texas Department of Transportation Disadvantaged Business Enterprise
ED/WOSB Economically Disadvantaged/Woman Owned Small Business
HUBZone
LEED Certification
MBE Minority Business Enterprise
SBE - Small Business Enterprise Certification
SDB Small Disadvantaged Business
SDVOSB Service Disabled Veteran Owned Small Business
Texas HUB Program
VBE - Veteran Business Enterprise Certification
VOSB Veteran Owned Small Business
WBE - Women’s Business Enterprise Certification
WOSB - Women Owned Small Business Certification
What do you need help with?
You must choose at least one.
*
Developing a business plan
Developing a financial forecast
Developing a package for financial funding
Developing a marketing strategy for the business
Developing a marketing strategy for a crowdfunding campaign
Developing a digital marketing campaign
Setting up and managing my social media campaign
Finding the right financial institution or lender
Designing a logo
Telling my company's story effectively or drafting the message
Developing a growth strategy
Selecting and setting up new apps (i.e. Quickbooks)
Salesforce.com or Soho CRM consulting
Developing curriculum
Corporate training services
Start Up Consulting
Finding the right real estate (location, purchase or lease) for my business
Learning how to start a business
Obtaining my permit or license
Please provide full details related to your consulting needs.
*
Which social media channels do you actively use for business?
Twitter
Facebook
Instagram
LinkedIn
Snapchat
Tik Tok
Other
Please specify
Facebook Link
Twitter Link
Instagram Link
LinkedIn Profile
Do you have a CPA, accountant, or bookkeeper?
Yes
No
Do you have a business attorney?
Yes
No
Please attach business plan document (if you have one)
Please attach company logo (if you have one)
Demographic Info
The following information is gathered for grant purposes and to support future program development.
What is your race/ethnicity (select one or more)
*
American Indian or Alaska Native
Black, African American
Caucasian
Asian
Native Hawaiian or Other Pacific Islander
Other
Prefer not to answer
Do you identify as Hispanic/Latino?
*
Yes
No
Prefer not to answer
Gender Identity
*
Female/Woman
Male/Man
Non-Binary / Gender non-conforming
Prefer to self-describe
Prefer not to answer
Age
*
17 years old or younger
18-34 years old
35-64 years old
65 years old or older
Prefer not to answer
Annual Income
*
Less than $20,000
$20,000 to $49,999
$50,000 to $99,999
Over $100,000
Prefer not to answer
Approved March 21, 2022 ID 377