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Entrepreneurs & Experts in Residence Application
I. Participant Information
Business Name:
*
DBA or Trade Name:
Business Address
Street
*
City
*
State
*
Zipcode
*
Phone Number
*
Contact Person
Name | Title
*
Email Address
*
II. Business Information
Date Business established:
*
+
NAICS Code:
Industry Type:
*
Accounting/ Finance/Legal Services
Building and construction
Building maintenance/ Pest Control
Computing and IT
Consulting
Childcare/ Daycare (Adult, childcare, and senior living)
Cleaning / Janitorial
Electrical/ Electronics
Environmental Technology and Services
Financial Services/ Investments
Food and Hospitality
Professional Services
Recruiting and Training
Health care
Manufacturing
Mixed businesses (groceries, small goods, etc)
Home improvement
Marketing
Real Estate and property management
Telecommunications
Transport
Other
Type of services or products provided:
*
Who do you sell to:
*
Consumers
Government
Businesses
Academia
Revenue:
*
$0 - $50K
$51K - $250K
$250K - $500K
$500K - $2M
$2M+
Number of Full Time Employees
*
How many individuals within your Household have a disability?
*
Why do you want to be a part of this Program?
*
Do you anticipate creating any additional full time jobs as a result of participating in this program?
*
Indicate what topics you’d like to discuss with the entrepreneur/expert in resident?
*
Are you willing to commit to meeting to scheduled meetings with your entrepreneur/expert in residence?
*
Which Coach would you prefer to meet with?
*
LaTanya Eggleston - Wellness and Communications Coaching
Ron Kaese - SBIR, STTR Proposal Writing, Commercialization Pathways Coaching
Bola Audena - Group Leadership Coaching
QC Jones - Government Contracting Coaching
Vennard Wright - IT/AI and Leadership Coaching
Glenn Helmann, Executive Management and Fund Raising Coaching
Mike Kelleher - Maryland Manufacturing Extension Program - Small Scale Manufacturing Coaching
Sara Keith - Maryland Manufacturing Extension Program - Small Scale Manufacturing Coaching
Kim Bryden - Food Product Coaching
Auran Sherreef - IT/App Development and other Technical Coaching
III. Ownership
Form of Ownership:
*
Sole Proprietor
Limited Liability Corp
Partnership
Corporation
Other
Please List All Owners
Name
Title
% of Ownership
Email
1.
Name
Title
% of Ownership
Email
2.
Name
Title
% of Ownership
Email
3.
Name
Title
% of Ownership
Email
4.
Name
Title
% of Ownership
Email
The following questions are for gathering statistical data only. If the business is owned and controlled primarily by individuals who are identified in any of the following categories, please check all the categories that apply:
*
African American/Black-Owned
Asian/Pasific Islander-Owned
Caucasian-Owned
Hispanic/Latino-Owned
Native American-Owned
Minority-Owned
Woman-Owned
Veteran-Owned
Certified MBE
County-Based
Prefer Not To Answer