Wisconsin Minority Business Development Agency (MBDA)

Xcelerate Prosperity Intake Form

Minority Business Development Agency
We are excited to invite Wisconsin entrepreneurs to join the Xcelerate Prosperity Program at the Wisconsin Minority Business Development Agency (WI MBDA) Business Center!

What is the Xcelerate Prosperity Program? It’s an innovative technical assistance (TA) services program designed to meet the evolving needs of entrepreneurs. Through our triage business model, we help you prioritize tasks, customers, and resources based on urgency and importance, ensuring focused support where it’s needed most. Fill out the form below to onboard with us so that we can walk alongside your business journey to support you as your prosper!

About the Minority Business Development Agency:

Established in 1969 by the U.S. Department of Commerce, the Minority Business Development Agency (MBDA) was solidified as a permanent fixture in the landmark Minority Business Development Act of 2021, a key component of the Bipartisan Infrastructure Investment and Jobs Act. The Wisconsin Minority Business Development Agency (WI-MBDA) services the state of Wisconsin. All business confidential information will be protected from disclosure to the extent permitted by law.
Contact Information
Form Date Field*

MonthDayYear
Name*

First NameLast Name
What is your role/title in the company?
Please identify which socially, economically, disadvantaged group, or ethnic minority group you belong to?
Personal Phone number
Please enter a valid phone number.
Personal Email address*
example@example.com
Personal Mailing address

Street Address

Street Address Line 2

City

Zip Code
Are you the majority owner of the business you are registering with the WI MBDA today?
if yes to the previous question, what percentage of the business do you own?
Business Account Demographics
Name of Business*
How many years has your business been legally established and operating?
What legal structure governs your business?*
What industry best describes your business?*
What is your primary NAICS code?
Please use the link below to find out your NAICS code if you are unsure: https://www.bls.gov/iag/tgs/iag_index_alpha.htm
What is your primary NIGP code?
Please use the link below to find out your NIGP code if you are unsure: https://vendornet.wi.gov/NIGPCodes.aspx
What is your current business status?*
Is your business a CERTIFIED Minority Business Enterprise (MBE)?
What organization granted your MBE certification?
What other business certifications do you have?
Ethnicity of majority business ownership
Gender of majority business ownership*
Business Mailing address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Business Phone number*
Please enter a valid phone number.
Business Email address*
example@example.com
Is the business registered with SAM.gov?*
What was the award amount of your highest paid contract to date?
What was the award amount of your 2nd highest paid contract to date?
What was the award amount of your 3rd highest paid contract to date?
Manpower Survey
How many employees does your business have including yourself?*
How many open positions do you currently have open, or how many people do you plan to hire this year?
Financing, Capital, & Bonding Survey
Do you need business financing or have you recently applied for business funding?
What is your current gross revenue?*
What was your gross revenue last year?*
Have you received any business financing this calendar year?
If yes to the previous question, how much?
If your business is insured and bonded, how much is your business insured and bonded for?
If you have already secured corporate or government contracts, what is the amount of your 1st, 2nd, and 3rd largest contract awards?
Wisconsin Minority Business Development Agency (WI-MBDA) Questionaire
Were you aware of the WI-MBDA Center prior to this survey?*
If you answered "Yes" to the previous question, how did you hear about the WI-MBDA Center? (Please specify)
Are you aware of the programs or services that MBDA Centers across the nation offer?*
If you answered "Yes" to the previous question, which programs or services are you aware of? (Please specify)
What types of contracts are you interested in? (Please specify any sectors or types of contracts)*
What is your preferred learning method?*
Do you have any other comments or questions?*
Disclaimer for Services*

WI-MBDABC is a federally funded agency, which enables us to provide our services at no cost to you. To keep these services free, we are required to show how we support Minority Business Enterprises (MBEs). All the information you provide is kept strictly confidential. Data shared for reporting purposes is only presented in summary form to demonstrate the impact of our services. Your personal information is never sold or shared with third parties.
Signature of Business Contact*

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Xcelerate Prosperity Intake Form

Contact Information

Business Account Demographics

Manpower Survey

Financing, Capital, & Bonding Survey

Wisconsin Minority Business Development Agency (WI-MBDA) Questionaire