The Refinery Application Form

The Refinery Application Form
Over the 8 week course we’ll work together to build confidence, clarity, and a practical plan for what's next for your business.

What you need to know:
- The course is completely free, funded by Wiltshire Council.
- The course runs over eight weeks, one full day a week.
- You need to attend every session, or arrange to catch up if you miss one.
- Each week builds on the last, with homework to help you reflect and prepare for what’s next.
- Places are limited, and not everyone who applies will get a space.
Please read all the information about the course on our website to give yourself the best chance of securing a spot on the Refinery.
Which course are you applying for?*

Salisbury, The Old Fire Station (Mondays, 3rd Nov – 22nd Dec)Chippenham, The Business Cyber Centre (Mondays, 5th Jan – 23rd Feb 26)
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Phone Number
Please enter a valid phone number.
Company Name*
Business Structure*

Sole TraderPartnershipLimited CompanyOther
When did you register your business?*

DayMonthYear
To be eligible for support your business must not be greater than 2 years old.
Where is your business located? *

Street Address

Street Address Line 2

City/TownCounty

Postcode
Upload a high-res copy of your logo

Cancelof
Which of the following business sectors do you fall within?*

Professional business servicesLife sciences and HealthcareWell-being, sports and recreational products and servicesFood and drink manufacturing or preparation (not retailers)Advanced Manufacturing and EngineeringICT, digital technologies and cybersecurityCreative industries, (arts, culture and entertainment)Education, skills and training providers
In short, what does your business do?*
What are your growth ambitions?*
How would you contribute to the supportive working environment during the 8-week Refinery course?*

Rate your confidence level with the statements below. 1 = Not confident, 5 = Very confident. (Please answer as truthfully as possible, your answers will not determine whether you are offered a place on the Refinery)*

	1	2	3	4	5
I understand the core foundations of my business and how to strengthen them.
I have developed or refined a viable product or service.
I feel confident managing the financial and operational needs of my business.
I understand who my customers are and how to reach them.
I have a clear and realistic action plan for business growth.I know what improvements I need to make to strengthen my operations.

Can you commit to attending the in person sessions, one day a week, for the duration of the course?*

YesNo
Please tell us about any accessibility requirements you have?
How did you find out about the programme?*

InstagramFacebookLinkedInDirect EmailThe Future SmithsJob Centre ReferralPersonal RecommendationNewsletterWebsiteWiltshire CouncilSwindon and Wiltshire Growth UnitOther
Would you like to be kept up to date with local support programmes and funding opportunities via our newsletters?

I consent to The Futuresmiths contacting me for the purposes above.
Date Submitted*

DayMonthYear
Date
Support Programme
Lifecycle Stage
Lead Status
Should be Empty: