Wealth Building Through Business Ownership Application

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 $100 for non-members and $50 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 NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Zip Code?*
What is the name of your business?*
How long have you been in business?*

1-2 years3-5 years6 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?*
Do you sell B2B or B2C*

B2BB2C
Are you certified (check all that apply)*

State CertifiedCity CertifiedMid-States CertificationWEBENCNo Certification
Is this your first business?*

YesNo
Do you have a marketing strategy?*

YesNo
What social media sites do you currently use?*

FacebookInstagramTikTokLinkedInTwitter
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?*

18-2021-2930-3940-4950-5960 or older
How do you identify?*

American Indian or Alaskan NativeAsian or Asian AmericanBlack or African AmericanHispanic or LatinXMiddle Eastern or Northern AmericanWhiteOption not available
Gender*

MaleFemaleNon-binary
What is your highlest level of education?*

Less than High SchoolHigh School degree or equivalent (GED)Some college but no degreeAssociates degreeBachelors degreeMasters degreeGraduate 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 employementFull-time employmentOther
Do you require accommodations for this course?*
Are you a member of the Indy Black Chamber of Commerce, Inc*

YesNo
What do you know about IBCC?*
What are your expectations from IBCC to benefit your business?*
What is your time preference for this course?

11:00am-1:00pm6:00pm-8:00pm
How did you hear about this course?*
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Business Intake Form