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Students
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Technical Assistance Application Fall 2025
Business Development Bootcamp Course
August 18 - October 29 on Monday & Wednesday 6:00 - 8:00 pm class time (8-9:00 pm optional office hour) No class the week of the Labor Day.
First Name
Middle Name
Last Name
Business Name
Tax ID Number
Stage of Business
Stage of Business
Thinking of starting a business
In process of starting or acquiring a business
Own a business in operation less than one-year
Own a business in operation 1-5 years
Own a business in operation over 5 years
Form of Business
Form of Business
Sole Proprietorship Using Own Name
Sole Proprietorship Filed DBA
Partnership
Corporation- Regular
S-Corporation
Corporation- LLC
Unknown at this Time
Business Types or/ Industries
Business Types or/ Industries
Agriculture
Retail
Service
Manufacturing
Producer
Construction
Finance, Insurance, Real Estate
Wholesale Distribution
Unknown at this Time
Usable Business Plan
Usable Business Plan
Yes
No
Partial, needs work
Website
Email Address
Mailing Address
Mailing Address
Country
Street
City
Region
Postal Code
Phone Number
Gender
Gender
Male
Female
X- Gender
Age Range
18-24
25-30
31-40
41-50
51-60
61+
Highest Education Obtained
Grade School
Junior High School
High School
GED
Trade School
Two-Year College
Four- Year College/ University
Graduate School
Doctorate
Ethnicity/ Race Group
Black/ Non-Hispanic
Black/ Hispanic
Hispanic/ Other than Black
Asian
Native American
White
Other
Business Facility
Business Facility
Home-Based
Own Outside Facility
Rent Outside Facility
Unknown
Income Generated is:
Income Generated is:
Main Source of Income
Supplementary Income
Unknown at this Time
Number of Full-Time Employees
Number of Part-Time Employees
Gross Revenues/ Sales $
For most recent FULL business year
Number of Owners
MWBE Certification Status
Certified
Application Process
Certification Denied
Have Not applied
Not Eligible
Certification Revoked
Recertification Application in Process
Application Rejected
MWBE Applied Date
MWBE Applied Date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
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29
30
31
2000
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2003
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2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
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2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
MWBE Certified Date
MWBE Certified Date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
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9
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22
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25
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30
31
2000
2001
2002
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2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
MWBE Denied Date
MWBE Denied Date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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20
21
22
23
24
25
26
27
28
29
30
31
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Date Business Started
Date Business Started
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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17
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19
20
21
22
23
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25
26
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28
29
30
31
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Designation Group/ Status
Designation Group/ Status
Veteran
Dislocated Worker
Disable Individual
MOB (Self-Declared Minority Owned Business)
WOB (Self-Declared Women Owned Business)
MWOB (Self-Declared Minority & Women Owned Business)
EAC Employment Status
EAC Employment Status
Employed Full-Time
Employed Part-Time
Self-Employed Full-Time
Self-Employed Part-Time
Displaced Homemaker
Unemployed
Public Assistance
Retired
Submit