The HUB Client Intake Questionnaire

The HUB Client Intake Questionnaire
Welcome! Thank you for reaching out to connect with the Central Upper Peninsula Small Business Support Hub (The HUB)!

To get your small business connected to The HUB’s network of support, services, programs, events, and resources, please respond to the questions below and submit this initial Intake Questionnaire. Your responses will help us determine your business’s eligibility for The HUB’s Programs and Services and identify which programs and services would be most beneficial for you.

Important Note: This is not a Direct Grant Application. Your business must meet specific program and service participation requirements to become eligible to apply for one of The HUB’s Direct Grants.

Confidentiality Notice: The HUB’s federal grant funding source requires us to collect specific information related to eligibility, demographics, and program metrics for reporting. We employ strict confidentiality procedures and practices to ensure the security of all privileged, confidential, and personally identifiable information provided to The HUB.

Once you have submitted your business’s information, a HUB Small Business Resource Navigator will review it and contact you.
YesNo
HUB Small Business Participant Updates:

IMPORTANT: DO NOT submit the HUB Client Intake Questionnaire form more than once per business!

If you have previously submitted a HUB Client Intake form for your business and want to supply us with updated information (e.g., LARA Registrations & Certifications, ownership change, Business Name Change, Website or Email Domain Name changes, Follow on Funding Received, etc,.),

EITHER, complete one of the Following Forms:

LARA Registration/Update Reporting Form

Follow On Funding Form

OR,

email your updated information to your HUB Small Business Resource Navigator:

Ilana Minor, iminor@mtu.edu

Jose Laynez, jlaynez@mtu.edu

Liam Goetz, liam@accelerateup.com

Robin Chosa, rlchosa@mtu.edu

Thank you!

Business Information

Basic Information
Intake Date*

MonthDayYear
Select Today's date.
Company Name*
Business entity's LEGAL NAME, include DBA if appropriate. Start-ups - list the working name of the business and add "- Ideation" after the working name.
Street Address*
List ONLY the business's physical STREET address; list the owner's STREET address for a business without a storefront, including a start-up. DO NOT include the city, state, or postal code, or list a P.O. Box address.
City*
State*
Two-uppercase-letter abbreviation for State
Postal Code*
Zip Code
County*
The HUB's coverage area includes Alger, Baraga, Delta, Dickinson, Marquette, Menominee, and Schoolcraft Counties.
Business Phone Number*
Please enter a valid phone number for the business: (000) 000-0000Format: (000) 000-0000.
Website
If applicable
Contact Information
Primary Contact
Primary Contact Name*

First NameLast Name
Primary Contact Full Name*
First and Last Name
Phone Number*
Please enter the Primary Contact's phone number: (000) 000-0000Format: (000) 000-0000.
Email Address *
Primary Contact's email address: example@example.com
YesNo
Owner Name
Owner Full Name
Owner Phone Number
Please enter a valid phone number (000) 000-0000.Format: (000) 000-0000.
Owner Email
example@example.com
YesNo
Owner 2 Name
Owner 2 Full Name
Owner 2 Phone Number
Please enter a valid phone number: (000) 000-0000Format: (000) 000-0000.
Owner 2 Email
example@example.com
Owner 3 Name
Owner 3 Full Name
Owner 3 Phone Number
Please enter a valid phone number: (000) 000-0000Format: (000) 000-0000.
Owner 3 Email
example@example.com
Preferred Contact Method*
Please select the way you would prefer to be contacted.
Preferred Contact Time*
Please select the time of day at which you prefer to be contacted.
Preferred Meeting Style*
Please select your preferred meeting style.

The HUB Client Intake Questionnaire

Business Information

Contact Information

Business Classification

Ownership Demographics

Supports

Support/Services Desired