Forms: GROW Application – WE CAN – Women's Empowerment through Cape Area Networking

GROW Group Member Application Form

Thank you for interest in WE CAN’s GROW Program. This program is limited to up to 8 participants per group. As such, once you complete this application we will set up an interview between you and a GROW facilitator. Following the interview we will notify you as to whether you have been accepted into the program. We use many factors that decide admission to a group and completing this application is not acceptance.

Application Deadline for Fall 2020 is October 14, 2020

Note: All info submitted in this form is confidential and will be held to WE CAN's strict confidentiality guidelines.

Part One: Participant Information

Date*

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

This phone is a:*

Cell
Land Line
Work Phone
Other

If other, please explain:

Email*

Part Two: Business Information

Name of Business*

Product or Service*

Business Address (if different from above)

Street Address Address Line 2 City State ZIP Code

Website

Is this a business start-up?*

Yes
No

Date business was (or will be) started

Type of business:*

Sole proprietor
Partnership
Limited Partnership
LLC
S Corporation
C Corporation
Other

If other:

% of ownership, If Corporation or Partnership

Employees, including owner:*

Full Time
Full Time - Seasonal
Part Time
Part Time - Seasonal

How many Full Time?

How many Full Time - Seasonal

How many Part Time?

How many Part Time - Seasonal?

In the next 12 months, do you plan to add employees?*

Yes
No

How many Full Time employees do you plan to add?

How many Part Time employees do you intend to add?

Approximate Annual Revenue:*

Profitable?*

Yes
No

Are you willing to share business financials with the group if necessary?*

Note: This is necessary to be accepted in the group.

Yes
No

Are you able to make a commitment to attend all sessions of the program?*

Yes
No

Your primary role in the business:*

What do you hope to gain from the GROW Group?*

Why did you start/buy/take over this business?*

What is your short-term goal for the business?*

What is your long-term vision for the business?*

What are the two biggest opportunities for your business right now?*

What are two concerns for your business right now?*

Are you currently in a program/working with an organization now focused on your business?*

E for All
CDP
SCORE
Other
None

If other:

What skills/experience do you have to make this business a success? Please check the area(s) where you need assistance:*

Growing the business
Developing a business plan
Sales and marketing
Budget/determining profitability
Obtaining financing/credit
Being the boss/managing people
Pricing
Other

If other:

Do you have a business plan?*

Yes
No

If no, do you understand the components of a business plan?

Yes
No

Do you have a working relationship with a bank?*

Yes
No

Which bank?

How does your support system (family, friends, business, colleagues) support you in running your business?*

Are there things that get in the way or make it difficult for you to run or manage a business?*

Did you start (or are you starting) this business due to being unemployed?

Do we have your permission to contact you after the program has concluded to gain your feedback on the program?*

Yes
No

To assist us as we plan future GROW Groups what is the best time to schedule GROW sessions?

Mornings
Afternoons
Evenings

Part Three: Demographics

WE CAN & the CDP have partnered to offer this program on the Lower/Outer Cape through funding provided by the Massachusetts Growth Capital Corp. The following information is used for statistical & grant purposes for WE CAN & CDP.

Gender:*

Ethnicity:*

Non-Hispanic/Latino
Hispanic/Latino

Race/National Origin:*

American Indian/Alaskan Native
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
White
Other

If other, please specify:

Citizenship:*

I decline to answer
I am a citizen of the United States
I reside in the United States after being legally admitted for permanent residence

Other:

Handicapped
Veteran

Part Four: Household

WE CAN & the CDP are applying for or has received services paid for with Federal funds to assist its operations. A condition of receiving those funds is that family income information be collected from each participant and is used for statistical reporting. The information you provide will be kept confidential.

Please answer for all household members, including yourself. Based on your most recent tax return, choose the selection below that matches BOTH the the number of persons in your household AND your family’s adjusted gross income range (line 7 on 1040). Please check only ONE box.

One-person household: Below $32,050
One-person household: $32,050 - $51,250
One-person household: $51,250 - $64,100
One-person household: Over $64,100

Two-person household: Below $36,600
Two-person household: $36,600 - $58,600
Two-person household: $58,600 - $73,200
Two-person household: Over $73,200

Three-person household: Below $41,200
Three-person household: $41,200 - $65,900
Three-person household: $65,900 - $82,400
Three-person household: Over $82,400

Four-person household: Below $45,750
Four-person household: $45,750 - $73,200
Four-person household: $73,200 - $91,500
Four-person household: Over $91,500

Five-person household: Below $49,450
Five-person household: $49,450 - $79,100
Five-person household: $79,100 - $98,900
Five-person household: Over $98,900

Six-person household: Below $53,100
Six-person household: $53,100 - $84,950
Six-person household: $84,950 - $106,200
Six-person household: Over $106,200

If none of these categories describe your household, please explain:

GROW Program Application

GROW Group Member Application Form

Part One: Participant Information

Part Two: Business Information

Part Three: Demographics

Part Four: Household

Contact Us

Telephone: 508.430.8111
Fax: 888.694.6199
Email: info@wecancenter.org

Office

783 Route 28
Harwich Port, MA 02646
M-F 9:30-4:30

GROW Program Application

GROW Group Member Application Form

Part One: Participant Information

Part Two: Business Information

Part Three: Demographics

Part Four: Household

Telephone: 508.430.8111 Fax: 888.694.6199 Email: info@wecancenter.org

783 Route 28 Harwich Port, MA 02646 M-F 9:30-4:30

Telephone: 508.430.8111
Fax: 888.694.6199
Email: info@wecancenter.org

783 Route 28
Harwich Port, MA 02646
M-F 9:30-4:30