HerBIZ Application

HerBIZ Application
Women Veterans: Before continuing, please confirm that you will be able to upload a copy of your DD214 or another official document verifying your military service at the end of this application.*

Yes, I can provide the required documentation.Not Applicable
Daughters of Veterans: Please confirm that you will be able to upload both your parent’s military service verification and your birth certificate showing your veteran parent’s name at the end of this application.*

Yes, I can provide the required documentation.Not Applicable
If you are not able to provide the required documentation at this time, please hold off on submitting the application until you are able to do so. If you have the necessary documents, you may proceed.
Name*

First NameLast Name
Phone*
Format: (000) 000-0000.
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
In which Florida county do you reside?*
Branch of Service*
What Component*
ex: National Guard, Reserve, Active Duty, etc.
Are You A Combat Vet?*

YesNo
Discharge Type*

HonorableGeneral Under Honorable ConditionsOther Than HonorableBad ConductDishonorableOther
Are you service-connected?*

YesNoOther
Entry Date*

MonthDayYear
Date
Discharge Date*

MonthDayYear
Date
Acknowledgment Required:*

I understand that I will be required to provide proof of military service, such as a DD214 or other official documentation.
What type of business do you want to start?*
Are you able to commit to 4-5 workshops a month plus 1 Saturday a month? (While we are in virtual mode, some workshops will require you to come in person.)*

YesNo
Do you have experience in this industry:*

YesNo
What is your highest level of education?*
List any professional development courses you have taken (Top 4):
Summarize why you want to start your own business, why you should be chosen to participate in the next Cohort of the HerBIZ program, and what your expectations of this program are:*
How did you hear about HerBIZ?*

VAWebsiteSocial MediaGoogle or other search engine211Previous attendeeAnother veteranHerVOICE Monthly NewsletterWomen Veterans Ignited Staff MemberOutdoor BillboardIndoor digital billboard inside a restaurantOther
Thank you for providing the requested information. Please upload your military verification in the section below, and don’t forget to submit the application to complete the process.
File Upload*

Accepted files: PDF, JPG, JPEG,PNG. Please note, the max size per document is 5 Mb / 40,000 Kb.
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Please verify that you are human by typing in the characters shown.*
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