Entrepreneurship Program Application Questionnaire

Entrepreneurship Program Application:

City of Refuge 1300 Joseph E Boone Blvd. Data collected in this form is covered by our privacy policy: https://www.cityofrefugeatl.org/privacy
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What best describes your current business status?
Tell us what motivates you to start (or grow) a business?
What is your primary reason for applying to the Entrepreneurship Program?
Other reason for applying
Tell us about your business or business idea.
Please briefly describe the product or service you plan to offer, who you intend to serve, and what makes your business unique.
Have you previously participated in any City of Refuge programs? If, yes, please elaborate.
What needs (or opportunities) do you see in your community, and how might your business address them?
What are you hoping to create, and what would you like your business to achieve as it grows?
What stage is your business currently in?
Which areas would you most like to develop through the Entrepreneurship Program? Select up to three.
What is the single biggest challenge you would like help addressing right now?
The Entrepreneurship Bootcamp includes 24 hours of required training. Are you able to attend and participate in all required training sessions?
The Entrepreneurship Bootcamp has a $25 participation fee. If paying this fee would create a financial hardship, would you like to request a fee waiver?
When a City of Refuge representative contacts you, they will discuss the fee waiver process.
The following demographic information is collected for equal opportunity, program reporting, and compliance purposes. This information will be maintained confidentially and will not be used to discriminate in determining eligibility, participation, or access to services. City of Refuge does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth, and related medical conditions, gender status, and gender identity), national origin (including limited English proficiency), age, disability, or political affiliation or belief.
Home Address
Apartment/Unit #
County of Residence
Street Address
City
State
Zip Code
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
What is your approximate annual household income before taxes?
What is Your Ethnicity?
Race

Please choose all that apply
US Citizen
Are you authorized to work in the US?
Highest Level of Education
Have You Served in the US Military?
Are You Disabled?
Gender
Are you currently employed?
Current Employer
Current Hourly Wage
Average Hours Worked Per Week
Program
Should be Empty:

Entrepreneurship Program Application:

Race