The Inspired Village Inc. Intake Form
Thank you for your interest in The Inspired Village! Please complete this form so we can connect you with the right programs, workshops, and opportunities.
Full Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
For gifting, program selection, and inclusion purposes.
Preferred Contact Method?
*
Email
Phone
Text
Social Media
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Are you interested as:
Individual looking for personal development
Current or aspiring entrepreneur
Real Estate Investor
Veteran Services
Contractor/ Construction professional
Private Money Lender
Prospective Tenant
Homeschooling Parent
Agriculture or holistic health professional
Elder care professional
Other
Are you a veteran or current service member in the U. S. Armed Forces?
Please Select
Yes
No
Program Interests
Which programs interest you? (Check all that apply)
Housing Heroes Program (Homeownership education & VA loans)
Credit Restoration & Financial Literacy
Intro To The Trades (Construction workforce training)
Kids' Cook & Canvas (Youth creative & culinary workshop)
Tax Tips & Strategies Workshop
Field Trips & Group Travel
Business Development Support
Community Events & Volunteering
Other
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Housing Heroes Program
Have you obtained your VA Loan Certificate of Eligibility?
Please Select
Yes
No
Do you have a copy of your DD214?
Please Select
Yes
No
Need help obtaining it
Do you need help with credit restoration?
Please Select
Yes
No
I don't know my credit score
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Business & Entrepreneurial Interests
Do you currently own a business?
Please Select
Yes
No
I would like to start a business
If no, skip to the next section.
Business Name
Website
If applicable
YouTube Channel
If Applicable
Most Active Social Media Account
LinkedIn preferred
Business Structure
Please Select
Sole Proprietor
LLC
S-Corp
C-Corp
Nonprofit
Not Yet Registered
Do you have a business bank account?
Please Select
Yes
No
Have you established business credit?
Please Select
Yes
No
Need Guidance
For Nonprofits- Do you have tax-exempt status?
Please Select
Yes
No
In Progress
What is your average monthly cash flow?
Please Select
Less than $5K
$5K- $10K
$10K- $40K
$40K or more
Do you need help with: (Check all that apply)
Developing ad copy for your website
Choosing the right apps for your business
Marketing & Branding Strategy
Funding options & Business Loans
If you have a budget for these services, how much is it?
Please Select
Under $500
$500- $1K
$1K- $5K
$5K+
Describe your business in a few sentences.
Elevator Pitch
How are you currently building relationships with potential referral partners?
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Real Estate Investors & Contractors
Are you a real estate investor?
Please Select
Yes
No
I'm seeking my first deal
If no, skip to the next section.
How many fix & flips have you completed?
How many properties are you currently holding?
Are you focused on:
Passive income for retirement
Workforce development & training apprentices
Expanding a real estate portfolio
Finding funding for real estate deals
Homeschooling & Education Interests
Do you have children under 18?
Please Select
Yes
No
Are they currently homeschooled, or are you interested in transitioning to homeschooling?
Please Select
Yes
No
Considering it
What support would help your homeschooling journey?
Social groups for kids
Hands-on learning experiences
Occasional childcare resources & referrals
Field trips & travel opportunities
Curriculum & educational resources
Children's Ages & Interests
For Program Development
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Travel & Field Trips
Would you be interested in local field trips (driving distance from Richmond, VA)?
Please Select
Yes
No
Do you have a passport?
Please Select
Yes
No
In Progress
Are you interested in group travel experiences?
Please Select
Yes
No
Event Participation & Community Engagement
Would you like to: (Check all that apply)
Attend workshops and events
Sponsor a workshop (help others attend for free)
Volunteer at an event
Speak on a conversational panel (online or in-person)
What is your Preferred Event Format?
In-Person
Online
Hybrid
Would you like to receive updates about upcoming programs & workshops?
Please Select
Yes
No
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Credit & Funding
Personal Credit Score
Self- Reported Estimate
Do you need funding for business growth, real estate, or personal goals?
Please Select
Yes
No
Unsure
Submit
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