ROBI Entrepreneurship Program Application
We're excited about your business idea. Let's get started!
Your Name
*
First Name
Last Name
Your E-mail Address
*
example@example.com
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your gender?
*
Please Select
Male
Female
Trans-Gender
Rather Not Say
What is your age?
*
Please Select
18-24
25-49
50-64
65+
What social service benefits do you currently receive?
*
TANF
SNAP
WIC
Medicare
Section 8
Pubic Housing
None of the Above
Highest level of education completed?
Please Select
High School Diploma / GED
Associates Degree
Bachelors Degree
Masters/Graduate Degree
Are you currently employed?
*
Please Select
Yes
No
Are you currently enrolled in school?
*
Please Select
Yes
No
Are you a veteran?
*
Please Select
Yes
No
Do you receive disability or SSI?
*
Please Select
Yes
No
What technology platform and skills do you currently have?
*
Microsoft Word
Microsoft Excel
Microsoft PPT
Gmail
Google Drive
G-Suites
Canva
Paypal
Zoom
Other
Do you need any special accomodations to complete this program? If so please list them below.
Do you have access to hi-speed internet and or Wi-Fi?
*
Please Select
Yes
No
What is your current annual household income?
*
Do you currently own a business?
*
Please Select
Yes
No
What kind of business do you have or would like to have?
*
What is your business name?
Is the Business License (Legal)?
*
Please Select
Yes
No
Have you made any sales?
*
Please Select
Yes
No
If you've made sales, what was your revenue last year?
How do you market your business (check all that apply)?
Website
Social Media / Ads
Word of Mouth
Email
Direct Mail
Trade Shows
Relationship Building
What is your Business Pain Points (Check all that apply)
Clarity of Vision
Funds to grow the business
Relationships
Increasing Sales
Marketing Knowledge
Writing Proposals/ Grants / Contracts
Other
Now, Choose the Top Pain Point (Only Choose One)
Clarity of Vision
Funds to grow the business
Relatioships
Increasing Sales
Marketing Knowledge
Writing Prposals / Grants / Contracts
Other
How did you hear about the program?
*
Please Select
Social Media / Internet
Friend / Family
Case Manager / Agency Staff
Radio
Other
Class Schedule Preferred
Please let us know which schedule you would prefer to attend classes
Preferred Class Times
*
Available Program Times
(Choose One)
Full-time (Day Program)
Monday - Friday
10:00 AM - 3:00 PM
Part-time (Evening Program)
Tuesday - Thursday
6:00 PM - 8:00 PM
Saturday (Coaching Only)
10:00 AM - 2:00 PM
Please verify that you are human
*
Submit
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