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1 Program Application Business Name: Address: City: State: ZIP: Website: Startup Date: Tax ID Number: Business Structure: Sole Proprietor Partnership LLC Corporation In what industry does your business operate? How many employees (including yourself) does your business have? Full- Time: Part- Time: Contractors: What is your typical employee’s hourly wage? Applicant (owner) Name: Title: Phone: Email: Applicant Gender: Male Female Are you a veteran? Yes No What % of time do you work in the business? Ethnicity: Black/African- American Asian White Latino/ Hispanic Native- American Other Highest education attained: High School or GED Technical or Professional Certification Associates Degree Undergraduate Degree Graduate or Post- Graduate Degree Describe the primary applicant’s day-to-day role(s) in operating the business. Please describe the business, product/service, including something novel or unique about it:

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Page 1: Program Application - Austin, Texas · By signing below, I hereby certify that the information provided above is true and accurate. I also certify that I understand that to fully

 

1

Program Application

Business Name:

Address:

City: State: ZIP:

Website: Startup Date:  

Tax ID Number: Business Structure:

Sole Proprietor

Partnership

LLC

Corporation

In what industry does your business operate?

How many employees (including yourself) does your business have?

Full-Time:

Part-Time: Contractors:

What is your typical employee’s hourly wage?

 

Applicant (owner) Name: Title: Phone: Email:  

Applicant Gender:

Male

Female

Are you a veteran? Yes

No What % of time do you

work in the business?

 

Ethnicity: Black/African-American

Asian

White

Latino/

Hispanic

Native-

American

Other

Highest education attained:

High School or GED

Technical or Professional Certification

Associates Degree

Undergraduate Degree

Graduate or Post-Graduate Degree

 Describe the primary applicant’s day-to-day role(s) in operating the business.

Please describe the business, product/service, including something novel or unique about it:

Page 2: Program Application - Austin, Texas · By signing below, I hereby certify that the information provided above is true and accurate. I also certify that I understand that to fully

 

2  

 How does the business reach its customers, i.e. how are products/services distributed or sold to your customers? (examples: direct sales, distributors, B2B, B2C, e-commerce, etc.)

Please describe the business’s main competitors:

What are the 3 main problems, challenges or issues that stand in the way of growing, expanding or sustaining your business, including implementing the creative or innovative ideas you have in mind for the business to succeed:

Explain the role innovation will or might play in your business and include up to 3 clear examples of creative or innovative ideas, strategies or programs that you think could positively impact your business and why.

What primary goals do you hope to achieve by participating in the Austin FASTFORWARD program?

By signing below, I hereby certify that the information provided above is true and accurate. I also certify that I understand that to fully benefit from Austin Fast Forward I must attend and fully participate in all classes and assignments, and that I will fully participate in periodic post-graduation surveys conducted by the Small Business Program. I also understand that the registration fee is non-refundable.

Signature:

Date:

Signature:

Date:


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