Financial Empowerment Program

Financial Empowerment Program
YesNo
Please note this is not a loan application.

Please email us if you experience an issue.

The final session will be in-person & virtual. If you are in the Dallas area and would like to attend in person, Veritex Community Bank 8214 Westchester Dr Ste 800, Dallas, TX 75225; Training - Westchester Alamo Room.
Personal Information
We are accepting registrations from the following locations:
TexasOther
Name*

First NameLast Name
Primary Email Address*
We will contact you at this email address
Personal Address*

Street Address

Street Address Line 2

CityState

Zip Code
Primary Phone Number*
We will contact you at this number
Business Questionnaire
YesNo
Loss RevenueFurloughed or Laid Off StaffReduced Employee HoursReduced Business Hours or OperationsClosed BusinessPhysical Damage or Losses
YesNo
Loss RevenueFurloughed or Laid Off StaffReduced Employee HoursReduced Business Hours or OperationsClosed BusinessIncrease RevenueNew Product or ServiceIncreased Customer BaseLaunched New BusinessHired New Employees
YesNo - Applied for COVID-19 related financial assistance but did not receiveNo - Did not apply for COVID-19 financial assistance
Yes - PPPYes - EIDLYes- GrantYes - Other COVID-19 related Loan
WebsiteSocial MediaEmailFamily/FriendTruFund Representative at an EventProfessional NetworkSearch EngineAdvertisement (Print, Digital, Radio, etc.)Other Organization
Name of Other Organization
WebsiteSocial MediaEmailFamily/FriendTruFund Representative at an EventProfessional NetworkSearch EngineAdvertisement (Print, Digital, Radio, etc.)Other Organization
Name of Other Organization
Yes, within 3-6 monthsYes, within 6-12 monthsYes, in more than 12 monthsNo, not at this time
Up to $15,000$15,001 - $25,000$25,001 - $50,000$50,001 - $100,000$100,001 - $200,000$200,001 or more
Sales and MarketingLeasehold Improvements/RenovationsPayroll/StaffingEquipmentInventoryGeneral Operating ExpensesBusiness RecoveryAll of the AboveOther
General Information
We are a 501(c)3 nonprofit – having information about who we serve supports our ability to demonstrate our impact and raise funding. Information that identifies you as an individual is secure and will never be shared with third parties without your consent.
FemaleMaleI decline to identifyOther
Black or African AmericanWhiteAsianAmerican Indian or Alaska NativeNative Hawaiian or Other Pacific IslanderMulti-RacialI decline to identify
Hispanic or LatinoNon-Hispanic or LatinoI decline to identify
Business Information
We are a 501(c)3 nonprofit – having information about who we serve supports our ability to demonstrate our impact and raise funding. Information that identifies you as an individual is secure and will never be shared with third parties without your consent.
Business Name*
Website
NoYes, operationalYes, but not operational at this time due to disruption
Years in Operation?*
Enter 1.3 for 1 year and 3 months or .8 for 8 months
Describe your business in a few words:*

0/70
Sole Proprietorship (Independent Contractor, DBA, Self-Employed, etc.)LLCPartnership (LP or LLP)C-CorporationS-CorporationNonprofit CorporationB-CorporationClose CorporationCooperative
If you have a legal business structure, how did you determine which structure to choose?
11 - Agriculture, Forestry, Fishing and Hunting21 - Mining, Quarrying, and Oil and Gas Extraction22 - Utilities23 - Construction31 - 33 - Manufacturing42 - Wholesale Trade44 - 45 - Retail Trade48 - 49 - Transportation and Warehousing51 - Information52 - Finance and Insurance53 - Real Estate and Rental and Leasing54 - Professional, Scientific, and Technical Services56 - Administrative and Support561- Janitorial Services562 - Waste Management and Remediation Services61 - Educational Services62 - Health Care and Social Assistance71 - Arts, Entertainment, and Recreation72 - Accommodation and Food Services81 - Other Services811 - Repair and Maintenance812 - Personal and Laundry Services8121 - Personal Care Services (Barbers, Stylist, Parlors, Spas, etc.)8122 - Death Care Services8129- Pet Care813 - Religious, Grantmaking, Civic, Professional, and Similar OrganizationsUnsure
Business to BusinessBusiness to ConsumerBusiness to GovernmentAll the Above
YesNoUnsure
Home-basedOfficeCo-Working SpaceVirtual OfficeWarehouse or FactoryOnlineRetail StorefrontSalon/SpaBuilding/ShopClinicMobile/Pop-UpOther
YesNo

YesNoUnsure
YesNo

YesNoUnsureN/A
NoYes, Part-timeYes, Full-time
Year To Date (YTD) revenue:*
This Date Last Year. Example: August 1, 2020 - August 1, 2021
Prior year revenue:*
Calendar Year. Example: January 1, 2021 - December 31, 2021
Current year projected revenue:
YesNo

YesNo
YesNoN/A

Rows	Number
Full-time
Part-time
Seasonal

Rows	Number
Independent Contractor/1099
Seasonal

How often do you review the following financial documents?*

Rows	At least once a month	At least quarterly	Twice a year	At least once a year	Never
Cashflow Statement
Income Statement/P & L
Balance Sheet

YesNo
QuickbooksFreshbooksXeroExcelOther
What do you hope to achieve by the end of the program?
What would success look like for you 6 months after completing the program?
What barriers do you anticipate facing that would make it difficult for you to achieve your vision of success?

Rows	Yes	No
Minority-owned business (51% or more)
Veteran-owned business (51% or more)
Woman-owned business (51% or more)
Disability-owned business (51% or more)
LGBTQ-owned business (51% or more)

Rows	Yes	No
Section 3 Business Concern
8(a) Business Development
HUBZone
Woman Owned Small Business
Economically Disadvantaged Woman Owned Small Business
Small Business
Small Disadvantaged Business
Service-Disabled Veteran Owned Small Business
Other State or Local Certification

Financial Empowerment Program

Personal Information

Business Questionnaire

General Information

Business Information

Sign and Submit