The Scale DSM Application

The Scale DSM Application
This application will take approximately 20 minutes to complete. Once you begin the application, you must complete all required fields; partially completed applications cannot be saved or submitted.
Applicant Name*

First NameMiddle NameLast Name
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Business Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Email Address*
Website*
Industry*
Referred by*
How did you hear about Scale DSM? (Check all that apply)*

Online MediaNewspaperCommunity OrganizationInterise WebsiteSpringGRMail or EmailOther
Race/Ethnicity:

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhitePrefer not to answerOther
Are you Hispanic/Latino?

Yes, I am Hispanic/Latino.No, I am not Hispanic/Latino.Prefer not to answer
Please provide a brief description of your business:*
What month and year did you start/buy your business?*
Are you the 100% owner?*

YesNoOther
Number of full-time employees: *
Number of part-time employees: *
Estimated annual revenue from last calendar year: *
Where do you hope to see your business in three years?*
How do you plan to make time to participate in the Scale DSM program? *
Are you currently a member of your local chamber of commerce?*
If you answered "Yes", which chamber of commerce are you a member of?
This free program, valued at $10,000 is being provided for you by the Greater Des Moines Partnership so that you can grow and sustain your business.

Questions? Contact: Juan Sanchez at jsanchez@dsmpartnership.com
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