Startup Space

PLEASE PROVIDE BUSINESS INFORMATION:

Business Name: *

Business Address: *
(example: 1234 Smith Street)

Business City: *

Business Zip Code: *

Primary Phone: *

Please select the industry that reflects your business sector: *

Please select the category that best describes your businesses estimated gross annual revenue. *

Please select the category that best describes the number of employees your business currently has. *

Legal Entity: *

DEMOGRAPHICS:
This information is confidential and will only be used for grant and reporting purposes.

Please identify which of the following best describes your race. *
This information is not shared with any outside party and is only used in aggregate to report on the communities we are serving.

Please indicate if you identify with any of the following. *
This information is not shared with any outside party and is only used in aggregate to report on the communities we are serving.

Please identify which of the following best describes your gender. *
This information is not shared with any outside party and is only used in aggregate to report on the communities we are serving.

Please select your preferred language: *

ACKNOWLEDGEMENTS AND CERTIFICATIONS

In consideration for receiving services through Elevate Business and by indicating my acceptance of these terms and acknowledgments below, the Business Client (hereinafter “I”) acknowledge the following:

1. Technical assistance services are being provided at no cost to Hennepin County Businesses through support from Hennepin County Housing and Redevelopment Authority, with additional administrative support provided by the Minneapolis Regional Chamber.

2. Technical assistance includes one-on-one business advising, coaching, cohort training, or informational sessions. I understand that unless otherwise expressly stated, any fees associated with the purchase and the ongoing administration of software, web site or other technology are my sole responsibility.

I understand that the business technical assistance services provided as part of the Hennepin County Business Resource Network known as Elevate Business HC is general business advice and does not replace my business judgment and experience when it comes to operating my business.*

Acknowledge

Check all that apply to you:*

My business establishment has fewer than 50 total employees.

My business substantially impacted by COVID-19, or required to close or reduce capacity by executive order due to COVID-19. Substantially impacted means a decrease of 10% or more in revenue in 2020. Your answer does not affect eligibility.

I am an aspiring entrepreneur who experienced negative economic impacts from the pandemic.

I forever waive all present or future claims against Hennepin County, Hennepin County Housing and Redevelopment Authority, Minneapolis Regional Chamber, and Elevate Business consultants and subconsultants relating to these advising services*

Acknowledge

The Information collected by this form is considered private data under the Minnesota Government Data Practices Act. The Hennepin County Housing and Redevelopment Authority (HRA) is collecting this information to better understand who is using this service. The HRA will use the information to improve service delivery to business owners. You are not legally required to provide information and may refuse to complete this intake form, but we cannot provide assistance under this program without it. If you opt to not provide the requested information your application may be denied; there are no other consequences associated with a refusal to provide the requested information. The following persons may access the information you provide: HRA and Hennepin County employees, the Minneapolis Regional Chamber, and any business advisor assigned to you. All data will be handled in compliance with the Minnesota Government Data Practices Act.

I give my consent to the Hennepin County Housing and Redevelopment Authority to share the information provided in this form with the Minneapolis Regional Chamber and with any business advisor assigned to me.*

Acknowledge

I understand that all Elevate Business services will be provided virtually and/or in accordance with Minnesota Department of Health guidelines.*

Acknowledge

I certify and represent that my business establishment or residence (if you do not have an established business) is located in Hennepin County.*

Acknowledge

I agree to complete surveys on the business advisory services provided through the Elevate Business platform within the timeframe requested as a condition of receiving services.*

Acknowledge

Hennepin County employees may use your email address to contact you for follow up purposes or to send you information relevant to small businesses.*

Acknowledge

Reconfirm Email: *

Print Name Here: *

e-Signature*

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2022 Connect with an Advisor: ACER

Complete this form to connect with ACER. A representative from this organization will follow up with you via email. A copy of this form will be provided to ACER and the business advisor you selected.

We are currently processing your application. Please keep this tab open until you see the green "Thank you for your submission" banner at the top of the page.

2022 Connect with an Advisor: ACER

Complete this form to connect with ACER. A representative from this organization will follow up with you via email. A copy of this form will be provided to ACER and the business advisor you selected.

We are currently processing your application.
Please keep this tab open until you see the green "Thank you for your submission" banner at the top of the page.