Economy and Business Advancement Services Intake Form

East African Dream Organization

Economy and Business Advancement Services Intake Form
Client Information
Full Name
Date of Birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Language: Interpreter Needed? Yes No
Preferred Language
Interpreter needed!
Business Information (If Applicable)
Do you currently own a business?
If yes, please fill in the information below:
Business Name
Business Type
Years in Operation
Business Address
Licensing Status:
Services Requested
Services Requested(Please check all that apply)

Other
Goals & Interests
1- What are your short-term business goals ?
2 - What is long term business goals?
3 - What challenges are you facing with starting or growing your business?
4- Have you Participated in any business training before?

If yes, please describe it
Additional Notes (For Staff Use Only)
Should be Empty:

Client Information