Business Intake Form
Please read each question thoroughly and don't leave any blank. This 10-week in-person business development training class is designed to embrace entrepreneurship by providing the foundation necessary to equip business owners for long term success. This class is geared for entrepreneurs who have been in business a minimum of 2 years and/or have generated > 25K in business revenue in the prior year. This cohort has a cost of $200 for non-members and $100 for members. This is an in-person course that takes place every Tuesday and Thursday. The course is aimed towards delivering educational concepts that impact your knowledge of business acumen and generate a strategic plan for business sustainability. Once your application is submitted we will notify you by email/phone if you were selected for this cohort.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Zip Code?
*
What is the name of your business?
*
How long have you been in business?
*
1-2 years
3-5 years
6 years or more
Is your business a Non-profit or For-profit?
*
What is your annual revenue with your business?
*
Less than $1,000
$1,001-$9,999
$10,000-$24,999
$25,000-$49,999
$50,000-$100,000
$100,001 and above
What is your business industry?
*
What is/are your NAICS code(s)?
*
Do you sell B2B or B2C
*
B2B
B2C
Are you certified (check all that apply)
*
State Certified
City Certified
Mid-States Certification
WEBENC
No Certification
Is this your first business?
*
Yes
No
Do you have a marketing strategy?
*
Yes
No
What social media sites do you currently use?
*
Facebook
Instagram
TikTok
LinkedIn
Twitter
Please provide your social media handles.
*
Do you have any previous business ownership experience? What were your highlights and what were your struggles?
*
Your age?
*
18-20
21-29
30-39
40-49
50-59
60 or older
How do you identify?
*
American Indian or Alaskan Native
Asian or Asian American
Black or African American
Hispanic or LatinX
Middle Eastern or Northern American
White
Option not available
Gender
*
Male
Female
Non-binary
What is your highlest level of education?
*
Less than High School
High School degree or equivalent (GED)
Some college but no degree
Associates degree
Bachelors degree
Masters degree
Graduate Degree
What is your current employment status?
*
Self Employed (less than 30 hours per week)
Self Employed (more than 30 hours per week)
Part-time employement
Full-time employment
Other
Do you require accommodations for this course?
*
Are you a member of the Indy Black Chamber of Commerce, Inc
*
Yes
No
What do you know about IBCC?
*
What are your expectations from IBCC to benefit your business?
*
What is your time preference for this course? *This is a gauge interest- your selection does not guarantee the final course time*.
11:00am-1:00pm
6:00pm-8:00pm
How did you hear about this course?
*
Please Select
IBCC Website
Minority Contractors Collaboration
Mid-States
Indy Chamber
IU Kelly School of Business
Other
If you selected "other" please let us know how you heard about this course?
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