Pathway's Micro Business Network Application

Personal Information
Pathways' Micro Business Network Participant Application

Thank you for your interest in the PMBN. This application helps us understand your business and determine how we can best support your growth. Please complete all sections thoroughly. All information provided will be kept confidential. Please insert N/A in fields you are unable to provide information.
Name

First NameLast Name
Address
City
State
ZIP Code
Phone Number
Email Address
example@example.com
Section 1: Business Information
Business Industry/Type:
Years in Business
Business Name
Address
City
State
ZIP Code
Business Phone Number
Business Email Address
example@example.com
Website if applicable
Do you have an EIN (Employer Identification Number/ Tax ID Number)? If yes, please provide it. If no, type N/A
Is or will your business be incorporated within the state of Pennsylvania or South Carolina?
Does your business operate or serve rural/ low income communities of South Carolina or Pennsylvania?
Please provide a copy of your Article of Incorporation documents

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Do you have an active business license for the town(s) you provide services in?
Please provide a copy of your business license

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Business Annual Income (from the most recent tax year): $
Number of Full-Time Employees
Number of Part-Time Employees
Section 2: Business Development
Do you have a Business Plan
What specific areas of your business do you need help with?
Section 3: Business Operations
Please describe the primary products or services your business offers.
Who are your target customers.
Do you have business Insurance?
Have you received any funding or grants in the past two years? If yes, please list funding sources.
Do you have a current marketing plan?
Do you have financial projections for the next 1-3 years? If yes, please provide.
What are your business's top three challenges?
What do you hope to gain from participating in the PMBN?
Section 3: Program Participants
By signing this application, I agree to:

1. Participate in at least one of the following assessments:
- DiSC Assessment: Gain insights into communication styles, teamwork, and productivity.
- Leadership Assessment: Identify strengths and areas for growth as a leader.
- Change Assessment: Understand how to adapt and lead through change effectively.
2. Attend monthly and quarterly information sessions to the best of my ability

3. Partake in
- Mentorship Opportunities
- Business Development Workshops
- Networking Events
Section 8: Membership Fee Agreement

As a participant of PMBN, I understand that there is an annual membership fee of $100.00.Payment is due during application submission and must be renewed annually to maintain active membership.
Section 9: Cancellation & Refund Policy for Annual Membership Fee

By signing this application, I acknowledge and agree to the $100.00 annual membership fee for participation in the PMBN. This fee is required for access to program benefits, resources, and networking opportunities. Cancellation Policy: Voluntary Cancellation: Participants may cancel their membership at any time by providing written notice to the program administrator at least 30 days in advance of the next annual renewal date. Involuntary Cancellation: Membership may be revoked by the program administrators if a participant fails to adhere to program guidelines, including non-compliance with required assessments, participation expectations, or unethical business practices. Refund Eligibility: If cancellation is requested within 30 days of payment, a full refund will be issued minus a $25.00 administrative processing fee. If cancellation occurs after 30 days of payment, no refunds will be granted. Non-Refundable Situations: Membership fees are non-refundable if a participant is removed from the program due to non-compliance or misconduct. Refunds will not be issued for participants who choose not to utilize program benefits after payment.

Pathways' Micro Business Network MembershipOne Year Membership Fee

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Personal Information

Section 1: Business Information

Section 2: Business Development

Section 3: Business Operations

Section 3: Program Participants

Section 8: Membership Fee Agreement

Section 9: Cancellation & Refund Policy for Annual Membership Fee