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TEC PARTICIPANT REGISTRATION
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GENERAL QUESTIONS

What is your current employment status?
Employed Full Time
Employed Part Time
Self Employed Full Time
Self Employed Part Time
On Disability/Wkr Comp
Unemployed
Other:

What is your Ethnic or Race?
Black/African American
Hispanic
Asian
Native-American
White/Caucasian
Other:

Please list any other services or programs that you are or have received from the Urban League of Greater Atlanta.

Do you own a computer with the Microsoft Office Suite installed?
Yes
No
Not Sure
Other:

Do you have high speed access to the Internet?
Yes
No
Not Sure
Other:

Would you be willing to receive training and coaching via the Internet? (i.e. Web conference, Webinars, etc. )
Yes
No
Not Sure
Other:

What is the current stage of your business?
Thinking of starting a business
In the process of starting or acquiring a business
Currently own a business that has been in operation for less than 1 year
Currently own a business that has been in operation for 1 to 5 years
Currently own a business that has been in operation for more than 5 years
Other:

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STARTUP BUSINESS QUESTIONS

What type of business do you have or plan on starting?
Retail
Service
wholesale, Distribution
Manufacturing
Construction
Finance
Insurance
Real Estate
Unknown at this time
Other:

Have you ever started a business before?
Yes
No
Other:

Reason for starting business?
(Select all that apply.)
Be my own boss
Work/Life Balance
Supplement Income
Grow Large Business
Pass on to family

Do you have a useable Business Plan?
Yes
No
Partial, Needs Work
Other:

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EXISTING BUSINESS QUESTIONS

What type of business do you have?
Retail
Service
wholesale, Distribution
Manufacturing
Construction
Finance
Insurance
Real Estate
Unknown at this time
Other:

What year was your business established?

What is the legal form of your business?
Sole Proprietorship
Partnership
Corporation
S-Corporation
LLC
501 c(3) Non-Profit
N/A

Where does your business operate from?
Home Based
own Outside Facility
Rent Outside Facility
Other:

Do you have a useable Business Plan?
Yes
No
Partial, Needs Work
Other:

What are your plans for funding your business?
(Select all that apply.)
Self Funded
Friends and Family
Seeking Business Loans
Seeking Investment Dollars
Seeking Grant Funding
Other:

Do you have a Business License?
Yes
No
Other:

Is your business registered with the Secretary of State in the state that your business resides?
Yes
No
Other:

Do you have a Tax ID number for your business?
Yes
No
Other:

Do you have a Business Bank Account?
Yes
No
Other:

Select any Certifications that your business has.
(Select all that apply.)
Minority Business (MBE)
Women Owned Businesses
SDB or Disadvantaged Business Enterprises (DBE)
8(a) Designation
HUBZone Business Enterprises (HUB)
Disabled Veteran Businesses (DVBE)
No Certifications
Other:

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COMMENTS

Please enter any other information or comments that you feel were not covered by this assessment.

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