NCRC Community Development Fund Intake
This form takes about five minutes. Your answers help us understand your business and what you are looking for.
Applicant and Contact Information
Full name
*
First Name
Last Name
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Preferred contact method
Phone
Email
Text message
Business or organization name
*
Website or social media
City
*
State
*
ZIP code
*
Business Profile
Legal structure
*
Please Select
Sole Proprietor
LLC
S-Corporation
C-Corporation
Partnership
Nonprofit
Other
Industry
*
Media & Journalism
Professional & Business Services
Retail
Construction & Trades
Health & Wellness
Food & Beverage
Arts, Culture & Entertainment
Technology
Manufacturing
Other
Current stage
*
Please Select
Idea or pre-launch
Startup (generating early revenue)
Growth (established, scaling)
Mature or stable
Year started
Number of employees
Briefly describe what your business or organization does
Revenue in your most recent fiscal year
Please Select
Not yet generating revenue
Less than $50,000
$50,000–$99,999
$100,000–$249,999
$250,000–$499,999
$500,000–$999,999
$1,000,000–$4,999,999
$5,000,000 or more
Prefer not to say
Do you have a business plan?
Please Select
Yes
No
In progress
Support Needs and Funding
What services are you seeking?
*
One-on-one business counseling
Loan & Financial Readiness Cohort
Live workshops & events
On-demand courses
Small business loan ($50,000–$500,000)
Other
What is the main thing you want help with?
About how much funding are you looking for?
Planned use of funds
Working capital
Inventory
Real estate
Leasehold improvements
Machinery & equipment
Marketing
Debt refinance
Other
When do you plan to apply for funding?
Please Select
Within 3 months
3–6 months
6–12 months
12–24 months
Unsure
How did you hear about us?
Please Select
Community partner or referral
Conference or event
Social media
Email or newsletter
Word of mouth
Web search
Other
Demographics and Consent
Race / ethnicity
Black / African American
Hispanic / Latino
Asian / Pacific Islander
Native American / Alaska Native
White / Caucasian
Other
Gender
Please Select
Woman
Man
Nonbinary
Prefer not to say
I agree to be contacted by NCRC Community Development Fund about my request
*
Yes
Submit
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