Fillable Small Business Management Program Application (Chemeketa Community College)

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Small Business Management Program Application (Chemeketa Community College)

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The Small Business Management Program Application (Chemeketa Community College) form is 1 page long and contains:

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Country of origin: US
File type: PDF

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S:\SBDC\A- SBM\Application-Program Outlines-Welcome Ltrs\2017-18\SBM Application 2017-18.doc Rev 2/2017
Owner/Applicant: ____________________________________ ($750) DOB:_________________
(used by Chemeketa in place of SS#)
Cell:_____________________________ E-Mail: _______________________________________
Have you taken a previous class from Chemeketa under a different name, if yes, what? _______________
Second “Key” Person (if applicable): ____________________ ($150) DOB:_________________
(used by Chemeketa in place of SS#)
Cell:_____________________________ E-Mail: _______________________________________
Have you taken a previous class from Chemeketa under a different name, if yes, what? _______________
Business Name:____________________________________________________________________
What products or services does your business provide? __________________________________________
Address: ______________________________________City, Zip____________________________
Entity: Sole Partnership LLC S Corp C Corp Other
Business Phone: __________________________ Web Page:_______________________________
Year Business Started: _____________
Annual Sales, previous December: _____________
Annual Profit, previous December: _____________
Number of Employees:
Full Time (include owners): ________
Part-Time: _______
Do you have an accountant? Yes No
Do you have a bookkeeper? Yes No
Do you have monthly financial statements?
Yes
No
Do you use accounting software?
Yes
No
If so, which one? ___________________
Version: _____________
What are your top three greatest business challenges?
1)
2)
3)
What is your greatest business strength?
What keeps you up at night?
How did you learn about the SBM program?
Are you a current Chamber of Commerce Member (members receive a $50 discount)? Yes No
Are you part of Chemeketa’s Accelerator Program? Yes No
Signature (typed name): Date:
Email application to lori.cegon@chemeketa.edu (Type your information
into the fillable areas, save your application to your computer then add the
application as an attachment.)
Other: Fax: 503.581.6017 or Mail: 626 High St. NE, Suite 210 Salem, Or, 97301
Name of Business: ________________________
Address: ________________________________
City, State, Zip: __________________________
Name of Business: ________________________
Address: ________________________________
City, State, Zip: __________________________
Name of Business: ________________________
Address: ________________________________
City, State, Zip: __________________________
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Small Business Management Program Application (Chemeketa Community College)

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Completed 3 October 2020

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