Name
*
First Name
Last Name
Business Title
*
Official Company Name
*
Primary Telephone #
*
Country
(###)
###
####
Email
*
Business Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
How many employees did you have at the end of the last fiscal year.
*
The Owner Only
2 - 6
7 - 11
12 - 20
21 - 30
31 - 50
More than 50
What is the legal structure of your business?
*
Sole Proprietorship
Limited Liability Company (LLC)
"C" Corporation
"S" Corporation
"B" Corporation
Nonprofit
Other
Is your business 51% or more owned by a female Veteran and/or military spouse?
*
Yes
No
Military Assoication
What is/was the associated branch of service?
*
Air Force
Army
Coast Guard
Marines
Navy
Other
What is your current status (check all that apply)?
*
Note, Military dependents do not qualify for this specific program.
How many years did you or your spouse serve (Active Duty and Reserve combined)?
*
Less than 3 yrs.
3 to 5 years
5 to 7 years
7 to 10 years
10 to 15 years
15 to 20 years
20 to 25 years
25 to 30 years
More than 30 years
Demograhics
Age Range
*
Under 21
22-35
36-45
46-55
55-65
Over 65
Ethnicity
Hispanic Orgin
Non-Hispanic Orgin
Race
*
If mixed race, please select all that apply.
Business Intake Assessment
What is your primary business industry?
*
Natural resources and mining
Construction
Manufacturing
Trade, transportation, and utilities
Information
Financial activities
Professional and business services
Education and health services
Leisure and hospitality
Other Services (except Public Administration)
Is your business your primary source of income?
*
Yes
No
Over the past 12 months please identify the percentage of revenue growth your business has achieved.
*
My business revenues have not grown
14% or less
15% - 20%
20% - 40%
40% - 60%
60% - 80%
80% - 100%
More than 100%
From the selection below, please identify the top three areas that would be most beneficial to your business.
*
QUICK SWOT ANALYSIS
Please share your company's most relevant strength? This could include current leadership, a product/service or internal business system or processes.
*
Please share what you perceive as your company's greatest internal weakness? This could include current leadership, a product/service or internal business system or processes.
*
Please share what you perceive as your company's most relevant threat? This could include the current economy, competitors, industry ytrends, etc.
*
Please share what you perceive as your company's current opportunities? This could include the current economy, new industry trends, etc.
*
Do you currently have a business mentor?
*
Yes
No
If you answer yes to the previous questions, please identify your mentor association.
*
N/A
VWEC
SCORE
Bunker Labs
Women Business Center
Veteran Business Outreach Center
Another Free Mentorship Program
Fee-based Mentor/Coaching Service
Select Session Availability
*
Please confirm you are available to attend the required technical assistance sessions.
Mondays 5PM - 7PM
Wednesdays 8AM-10AM
Fridays 11AM - 1PM
Saturdays 8AM - 12PM
Note availability for required session will impact potential program selection.
All times are listed based on central standard time
Please share any additional information you believe is relevant to your selection as a candidate for this program.
Required Vertification & Financial Documents
*
Ensure your business name is included with every document uploaded.
Woman Veteran/Female Military Spouse Verification Documentation
*
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Woman Veteran/Female Military Spouse Majority-Owned Business Verification Documentation
*
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Length of Time in Business Verification Documentation
*
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Cash Flow Statement
*
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Profit & Loss Statement
*
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Balance Sheet
*
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Last 2 Years of Tax Statements
*
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Business Bank Statement
*
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Business Bank Statement
*
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