Passion to Purse Program Application

Please read the application carefully. All applications must be filled out completely. Any applications that are not fully completed will not be considered.

Note: Classes are open to only women and women who are the sole owners of a small business. You must have access to a computer in order to participate in the online portion of the classes. Once applications are reviewed, qualified applicants will be required to come in for an interview. Acceptance emails will go out after the interview process has concluded.

Class Schedule

Session 2

April 3 – May 26, 2017

Session 3

August 21 – October 3, 2017 (no class on Labor Day)

Session 4

October 30 – December 19, 2017 (no classes week of November 20)

Session 2 classes will be held Monday & Tuesday from 10-noon. Night classes are available if there is adequate interest.

Program Application

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

Date

First Name *

Last Name *

Birth Date (MM/DD/YYYY) *

Street Address *

City *

County

Zip / Post Code *

Email *

Phone: Home Help Text

Phone: Cell * Help Text

Phone: Work Help Text

Can you receive call at work?

My preferred training class times are:

Morning (9am - Noon)
Afternoon (Noon - 4pm)
Evening (4pm - 8pm)

Are you a Veteran?

Do you have a disability?

Are you a single parent?

Do you file taxes as head of household?

How many people live in your household? (include yourself)

Company Name

City of Current Employer

Your Current Wage (Mark Hourly or Yearly)

What was your last year annual gross income?

What is your Current household’s TOTAL monthly gross income

Did you save any money last year?

If yes, how much did you save?

Do you currently receive any form of public assistance? *

Other Benefits?

Do you have health insurance?

Have you ever operated a business?

Do you currently operate a business?

If so, how long have you been in operation?

Business name:

Description:

Which of the following apply to you? (Choose as many as you like)

Trying to decide if business ownership is right for me, or if my business idea is viable, through the development of a plan.
I have started a business, but I’m struggling with the basic practices.
I need assistance to stabilize my existing business.
Other (specify below)

What is your passion? *

Do you currently have an idea for a business?

Describe idea:

Do you have the necessary technical skills for this business idea?

If no, describe your plan to acquire the skills:

What skills do you have?

Do you need childcare to attend the classes?

How much money would you like to make from your business each year?

What are the issues that you are having in your personal life/business that are preventing you from successfully doing what you want to do in life?

How can this program help you and why do you want to participate in this program?

I need assistance and/or to learn about finding capital to expand my existing business.

This program is mostly funded by the Women to Women Foundation. Some women will qualify to attend for free. Those that do not qualify may be able to participate by paying a fee, if maximum capacity is not met.

Are you interested and able to pay a fee to attend these classes?

Participants must be committed to coming to all classes, doing all assigned homework, actively working on their businesses and want to start making money now. Students cannot miss more than 1 class and must notify instructor prior to the beginning of class.

Are you able to commit to this program?

Confidentiality Agreement:

By typing my name below, dating, and submitting this form, I agree that all the information in this application is true to the best of my knowledge. If selected to participate in the Passion to Purse Program, I authorize the ongoing sharing of information with Operation JumpStart, including this report and any future progress, attendance, and/or termination. I understand all information will be kept confidential and only used in a collective form.

Full Name *

Date *