Online Program Application Please complete the application below. If you have any questions, please contact us. Step 1 of 3 33% Contact InformationPlease complete all information in this section.Name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*How did you hear about this program?*FacebookTwitterGoogleWebsiteReferralIf you were referred to our program, who referred you? Demographic InformationInformation provided in this section is optional.Highest level of education completed:Finished Grade SchoolGraduated from High SchoolSome CollegeCompleted Associates DegreeCompleted Bachelors DegreeCompleted Masters DegreeCurrent employment status:Employed full-timeEmployed part-timeLaid off/furloughedUnemployedApproximate Household Income:Less than $25,000/year$25,000 - $49,999/year$50,000 - $74,999/year$75,000 - $99,999/year$100,000 - $149,999/year$150,000 - $199,999/year$200,000 - $299,999/year$300,000 and upNumber of people in your household?Please enter a number from 1 to 12. Pre-program SurveyPlease complete this section to help us understand your needs.Do you currently have a business?YesNoWhat is the name of your business?What kind of business would you like to start?Describe any experience you have in this area of business:Do you plan to use what you learn in our program to improve your existing business, or are you thinking of starting a new business?I want to improve my existing businessI want to start a new businessWhat are your goals for starting a business?What are your goals for improving your current business?What are you hoping to learn in this program?What topics would benefit you most? Please check all that apply. Select All Marketing Business Plan Development Record Keeping Legal Sales Presentations Social Media Financial Modeling Human Resources Other Please rate your knowledge in each area:I have no idea what I'm doingI know a little bit, but I'm challenged in this areaI know enough to make me dangerousI'm pretty good at thisI'm a superhero in this areaMarketingSalesFinancial ModelingBusiness Plan DevelopmentSmall Business Human ResourcesFinancial Record KeepingSocial MediaLegal Issues for Small BusinessQuickbooks/Accounting SoftwareWhat kinds of insurance do you have? Please check all that apply. Select All Health Car Business What types of bank accounts do you have? Please check all that apply Select All Personal checking Personal savings Business checking Business savings I have access to (please check all that apply): Computer and/or laptop Tablet Reliable internet service/WiFi Program Tuition* Price: $250.00 Total $0.00 Date* Date Format: MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
