Small Business STRONGER for Economic Mobility - Delaware Leadership Application Form

Small Business STRONGER for Economic Mobility Leadership Application
Offered by Delaware Black Chamber of Commerce

Thank you for considering our program and taking the time to complete the executive leadership application. We are excited to review your submission and learn more about how you can contribute to the economic mobility of your business and employees.

This application will take approximately 7 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 / Province

Postal / Zip Code
Business Phone*

Area CodePhone Number
Cell Phone*

Area CodePhone Number
Email Address*
Website*
Industry*
How did you find out about the program? (Check all that apply)*

Direct recruitment by the Program ManagerEmail or online newsletterLocal media (newspaper, television, radio, etc)DEBCC staff memberInstructor referralInterise Social MediaPast participant referralInterise staff memberLenderCity or government officialSocial Media, please indicate below:Technical assistance provider referral (SBA, SBDCs, SCORE, WBC, etc)Other
Race/Ethnicity:*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteOther
Are you Hispanic, Latino or Spanish origin?*

Yes, I am Hispanic or Latino.No, I am not Hispanic nor 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: *
Number of contracted employees:*
Estimated annual revenue from last calendar year: *
How much funding have you received and how did it come in? (Check all that apply)*

Less than $10 KLoan$10 K - $25 KGovernment funding$25 K - $50 KPrivate funding$50 K - $100 KCorporate funding$100K +Line of CreditNo fundingAnchor Institutions (ie: hospital, university)Other
Are you a graduate of a StreetWise MBA program?*

YesNo
If no, have you participated in any other small business capacity building programs? If so, please describe below.
Why do you want to be in this program?*
In what ways have you improved the job quality and/or job satisfaction for your employees? Check all that apply:*

Paid Time OffEducation StipendFlexible schedule/Remote Work OptionsMentorshipChildcare StipendAnnual Salary RaisesApprenticeship/Job Training OpportunitiesHealth InsuranceTechnology Stipends (phone bill, internet, etc)Leadership Opportunities/PromotionsNoneOther
I agree to attend and participate in the in-person workshop and five virtual sessions:

YesNo
Should you have any questions or require further information about the program or the application process, please do not hesitate to reach out to Ayanna Khan at email@debcc.org.
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Small Business STRONGER for Economic Mobility Leadership Application