First Name: *
Last Name: *
Email Address: *
Date of Birth: *
Address: *
City: *
State: *
ZIP Code: *
County: *
Phone: *
What program are you studying? *
What type of work do businesses/individuals typically contract with you to complete? *
What type of business do you operate, or wish to operate? * Example: Lawyer, consultant, bookkeeper, graphic artist, restaurant
What is the name of your business? * If your business does not yet have a name, please type N/A.
How did you hear about this program? *
What are you hoping to gain from Partners in Entrepreneurial Pathways 1.0 - Venture Exploration? *
We strive to develop and deliver classes and workshops, assistance, and services in an inclusive, diverse, and equitable manner--first and foremost. Providing the following confidential details will help us ensure that we are doing so. Identifying details will not be shared outside of enrollment. You have the option to select 'Prefer not to answer' on any details you are not comfortable sharing.
Gender *
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