Starter Company PLUS Expression of Interest and Intake Form

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Pour recevoir information ou un soutien en français, veuillez contacter Aïssatou Sonko, Responsable des services d'appui aux entrepreneur·e·s, au 647-510-3445 ou aissatou.sonko@fedefranco.ca

Name*

First NameLast Name

Your Business Name or Proposed Business Name

Contact Number*

E-mail*

example@example.com

Website or primary social media page if you have one

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If your business is currently operating, when did you start operating)?
blanks Month blank Year

If your business is already registered, when did you register your business?
blanks Month blank Year

If known, please indicate the structure of your business:

Sole ProprietorshipPartnershipCorporationNot sure or not yet registered

If you are already operating, how many people are currently employed by the business (including yourself as owner/operator)? Use 0.5 to count any part time staff.

Briefly describe your business or business idea in a few sentences.*

Have you registered with the Business Enterprise Centre before?*

Yes, for this businessYes, for another businessNo, this is my first visit

Preferred method(s) of any related consulting appointments:*

Virtual - TelephoneVirtual - MS TeamsIn person

Where did you hear about the Starter Company PLUS grant and programming?*

I am interested in applying for the Starter Company PLUS grant to support:*

starting a new businessgrowing an existing business

What are you hoping to get out of the Starter Company PLUS grant and any associated programming?*

Is your business registered in the Province of Ontario showing an address in Lambton County (or will it be by the time you submit your SCP grant application)?

YesNo

Do you have a commercial business bank account set up corresponding with your Business Registration documentation (or will it be by the time you submit your SCP grant application)?

YesNo

Are you over 18 years of age at the time of application and not currently enrolled in a post-secondary institution?*

YesNo

Are you a resident of Ontario?*

YesNo

Are you a Canadian Citizen or permanent resident of Canada?*

YesNo

Have you received a Starter Company grant in the past?*

YesNo

Do you have a well-developed business idea for a new or growing business that you can build a strong business plan and SCP application on? (Without this you are not likely to be successful with your application for the SCP grant. In that case we would encourage you to further develop your idea and apply for the next round of funding.)*

YesNo

Are you able to contribute a minimum personal financial investment equal to at least 25% of the grant amount ($1,250) to support the growth of your business?*

YesNo

Are (or will) any certifications or licenses required to operate your business in place and current at the time of your SCP grant application?*

YesNo

Do you self-identify as one of the following groups? If yes, select all that apply.

Francophone2SLGBTQ+Youth under 30 years of ageNewcomers to Canada (Newcomers to Canada (landed immigrants who came to Canada up to 5 years prior to a given census year)I prefer not to answer

Do you self-identify as a person with one or more disabilities?

YesNoI don't knowI prefer not to answer

Do you self-identify as First Nations, Métis, and/or Inuit? If yes, select all that apply.

Yes, First NationsYes, MétisYes, InuitI prefer not to answer

Do you self-identify as part of any of the following groups? If yes, select all that apply.

Do you self-identify as:

The Sarnia-Lambton Economic Partnership (SLEP) and associated Business Enterprise Centre (BEC), or Small Business Enterprise Centre (SBEC), recognizes the importance of the privacy and protection of clients' personal information. Personal information may be required in connection with purchases, service requests, event registrations and program applications. The information you provide will not be used except as reasonably required to provide our services.

Any information you provide that is not publicly available will be treated as confidential.

We only collect, retain and use personal information where it is essential for the following purposes:

Process your requests for services, products or further information
Communicate with you regarding services or products you have requested
Identify you if you have a question or concern about a service or product you have requested
Advise you about changes to our service offerings and of service interruptions
Meet legal and regulatory requirements
Meet requirements of our County and Provincial government funding partners

Your business profile will be disclosed to supporting Starter Company PLUS program delivery (i.e. training) partners. It will also be disclosed the Ministry of Economic Development, Job Creation and Trade and the Government of Ontario to verify service delivery of the BEC and collect feedback by requesting clients participate in a voluntary survey regarding programs and services received through our organization.

For more information about this collection, please contact:
Ministry of Economic Development, Job Creation and Trade
Business Partnerships and Programs Division
Talent and Entrepreneurship Branch
2 Queen Street East, 3rd Floor
Toronto, ON M5C 3G7

I understand and provide consent to the Sarnia-Lambton Economic Partnership and associated Business Enterprise Centre to maintain records of my personal or business information and share (as required) with regulatory and/or government funding bodies and any associated Starter Company PLUS program delivery and (i.e. training) partners:*

YesNo

I understand that I am solely responsible for the planning, implementation, financing, operation, success and development of my business. Any advice or suggestions made are for my consideration and I am not bound to take any such advice or suggestions and can obtain advice and assistance from any source, but ultimately any decisions pertaining to my business is my responsibility. I release the representatives from the Sarnia-Lambton Economic Partnership and the Business Enterprise Centre from any claim for loss or damages suffered by me or my business, in connection with the counselling or consultation provided:*

YesNo

Signature*

Starter Company PLUS Expression of Interest and Intake Form

Starter Company PLUS Applicant and Business Eligibility Requirements (see website or advisor for more information)

Additional Voluntary Disclosure Information