YWCA - WE 360 Registration Form

YOUR NAME*

MS. / DR. ETC.FIRST NAMEMIDDLE / INITIALLAST NAMEJR. / III / ESQ / ETC.
YOUR EMAIL*
YOUR MAILING ADDRESS*

STREET ADDRESS OR PO BOX

Street Address Line 2

CITYSTATE

ZIP CODE
YOUR PHONE NUMBER*

AREA CODEPHONE NUMBER
Where did you hear about this program?

Social Media (Facebook, Instagram, LinkdeIn)YWCA NewsletterYWCA Staff Member/Volunteer/Board MemberOther
YOUR ENTREPRENEURSHIP STATUS*

Discoverer I: I intend to start a businessDiscoverer II: I currently own a business that produces $30,000 or less in annual revenueProver I: I currently own a business that produces $30,000 to $120,000 in annual revenueGrower: I currently own a business that produces $120,000 to $600,000 in annual revenueScaler: I currently own a business that produces $600,000 or more in annual revenue
YOUR INDUSTRY (FOR WE 360° RECORDS ONLY)

BeautyConsultingEcommerceEducationFaith-based organizationFinancial services & insuranceFood & beverageHealthcareHospitalityHuman resources & trainingLogisticsPublic speakerReal estateRetailSales & marketingTechnologyOther
YOUR RACE (FOR WE 360° RECORDS ONLY)*

American Indian/Alaskan NativeAsianBlack / African descent: having origins in Sub-Saharan AfricaHispanic / Latino / Latinx: identify as Hispanic or Latino with ties to Latin AmericaMiddle Eastern / North African: including the Middle East, North Africa, the Arab WorldNative Hawaiian or Other Pacific IslanderWhite / European descentIndigenous: Alaskan Native, First Nations, Native American, Native Hawaiian, SamoanMy race/ethnicity is not represented abovePrefer not to answer
YOUR AGE (FOR WE 360° RECORDS ONLY)*

20-2223-3536-4950-64
YOUR AGE (FOR WE 360° RECORDS ONLY)*

Under 1818-2425-3435-4950-6465+
YOUR GENDER (FOR WE 360° RECORDS ONLY)*

FemaleMaleTrans female: assigned male at birthTrans male: assigned female at birthNon-binaryGender non-conformingMy gender identity is not represented abovePrefer not to answer
YOUR PREFERRED PRONOUN (FOR OUR RECORDS ONLY)*

He / him / his / himselfShe / her / her / herselfThey (singular) / them / their / themselvesEy / em / eir / eirselfSie / sie / hir / hirselfTey / ter / tem / terselfVe / ver / vis / verselfZie / zir / zirs / zirself
YOUR INCOME (FOR WE 360° RECORDS ONLY)*

$19,140 +$25,860 +$32,580 +$39,300 +$46,020 +$52,740 +$59,460 +$66,180 +
COMMENTS (IF ANY)
YOUR DESIRED SESSION*
WE 360° PRE-SURVEY
I CAN CLEARLY CONVEY MY BUSINESS CONCEPT*

Strongly agreeAgreeSomewhat agreeNeither agree nor disagreeSomewhat disagreeDisagreeStrongly disagree
I HAVE IDENTIFIED A LOCATION TO OPERATE MY BUSINESS*

Strongly agreeAgreeSomewhat agreeNeither agree nor disagreeSomewhat disagreeDisagreeStrongly disagree
I UNDERSTAND THE PURPOSE OF A BUSINESS PLAN*

Strongly agreeAgreeSomewhat agreeNeither agree nor disagreeSomewhat disagreeDisagreeStrongly disagree
I HAVE IDENTIFIED MY BUSINESS' TARGET AUDIENCE OR CUSTOMER GROUP*

Strongly agreeAgreeSomewhat agreeNeither agree nor disagreeSomewhat disagreeDisagreeStrongly disagree
I HAVE AN ANNUAL BUDGET AND REGULARLY REVIEW MY FINANCIALS*

Strongly agreeAgreeSomewhat agreeNeither agree nor disagreeSomewhat disagreeDisagreeStrongly disagree
I MANAGE MY FINANCES IN A MANNER CONSISTENT WITH A SUCCESSFUL BUSINESS*

Strongly agreeAgreeSomewhat agreeNeither agree nor disagreeSomewhat disagreeDisagreeStrongly disagree
MY MARKETING STRATEGY IS SUFFICIENT TO PROMOTE MY BUSINESS*

Strongly agreeAgreeSomewhat agreeNeither agree nor disagreeSomewhat disagreeDisagreeStrongly disagree
I HAVE CONFIDENCE IN MY PLAN FOR FUNDING MY BUSINESS*

Strongly agreeAgreeSomewhat agreeNeither agree nor disagreeSomewhat disagreeDisagreeStrongly disagree
I'VE COMPLETED ALL LOCAL / STATE / USA LEGAL FORMS NEEDED FOR MY BUSINESS*

Strongly agreeAgreeSomewhat agreeNeither agree nor disagreeSomewhat disagreeDisagreeStrongly disagree
I AM PLEASED WITH MY LAUNCH / RE-LAUNCH PLAN*

Strongly agreeAgreeSomewhat agreeNeither agree nor disagreeSomewhat disagreeDisagreeStrongly disagree
By typing your name below, you give us permission to share your image as a participant in this workshop course on our social media, website, and/or materials. Thank you!
YOUR SIGNATURE*
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WE 360° PRE-SURVEY