Name of Business
First name of owner(s)
Last name of owner(s)
Phone
*
Email
*
Full Business Address
*
City
*
State
*
Zip Code
*
Website
Year business was established
*
Demographic of owner applying:
Veteran owned
Minority owned
Woman owned
None of the above
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Race/Ethnicity of owner applying
Caucasian/White
Hispanic/Latino
Black/African American
Native American/Alaskan Native
Middle Eastern/North African
Mixed/Multiracial
Other/do not wish to answer
No elements found. Consider changing the search query.
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Products/Services offered
Accommodation & Food Services
Admin & Waste Management
Arts & Entertainment
Construction
Health Care & Behavioral Assistance
Manufacturing
Professional Services
Retail
Transportation
Wholesale
Other
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Number of full-time Employees
Number of part-time Employees
Last year's revenue.
Last year's annual revenue range.
Under $500,000
$500,000-$1,000,000
$1,000,000-$5,000,000
$5,000,000-$10,000,000
$10,000,000 or more
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General net income for last year.
Please list combined revenue for last 3 years.
Describe revenue trends:
increasing
stable
sporadic
declining
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Have you outlined 2-3 key leaders for your exit?
Yes
No
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Outline any significant capital requirements of your business (describe uses and anticipated costs)
Do you foresee any upcoming changes in your business? This can include expansion, or new products/services offered. (expansion, new products offered?)
How did you hear about this opportunity for the program?
News article/press release
Colleague/word of mouth
MICEO event
Internet search
Social media
LEO newsletter
SBAM
Other
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What is your motivation for considering employee ownership? Share your personal and business goals for employee ownership.
Anything else you’d like to share before you submit?
Submit for the Workforce Development Grant
Please submit any documents ( such as a prior feasibility study ) here.
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