PLEASE READ & SIGN BEFORE CONTINUING WITH FORM
REQUEST FOR ASSISTANCE AND CERTIFICATION
I request business management counseling and/or training from the Women’s Business Enterprise Center East. I agree to cooperate should I be selected to participate in surveys designed to evaluate WBEC-East services. I further understand that any counselor or trainer in this program has agreed not to: (1) recommend goods or services from sources in which he/she has an interest and (2) accept fees or commissions developing from this counseling or training relationship. I waive all claims arising from this assistance against all personnel of WBEC-East, its parent or sponsoring organization, if any, and its host organizations, and other resource counselors.
I certify that all my statements contained on this form are correct to the best of my knowledge and that I will cooperate in providing follow up information needed to evaluate the effectiveness of the program if asked by an authorized representative of the Women’s Business Enterprise Center East.