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Momentum 360 Application - Fall 2019
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Momentum 360 Program Application
Please fill out this form as completely as possible, and sign and date the bottom of the form. Incomplete or invalid information will not be processed. The deadline to submit an application is October 1, 2019.
PART A: BUSINESS INFORMATION
Business Owner Name
Phone Number - Business
Phone Number - Cell Phone
Are you already in business and being paid for your product or service?
If so, how many years in business?
Business Facebook Page (if applicable)
Provide a brief description of your business. If not yet in business, summarize your new business idea.
PART B: ADDITIONAL INFORMATION
How will Momentum 360 improve your business management. What challenges are you looking to overcome?
Is your annual household income below $60,000?
-- Select One --
Pacific Islander/Native Hawaiian
How did you hear about Momentum 360?
-- Select One --
PART C: AGREEMENT AND SIGNATURE
Applicants must attend 8 weeks (once weekly) of a small business course held at The Small Business Center at Durham Tech in downtown Durham. This is provided free of charge. Each class is 3 hours long, includes light dinner, and will be held on Tuesday evenings 6:30 pm - 9:00 pm in Fall 2019. The assignments are online so you need reliable access to a computer and can expect approximately 3 hours of homework each week. By submitting this form, I am agreeing that, if selected, I am able to attend 100% of these Tuesday night classes.
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