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Start Small Think Big
Application for Assistance


Start Small Think Big provides free small business legal assistance and financial consulting to qualified entrepreneurs and small business owners. This application helps us determine whether you qualify for our services. It also helps us to determine exactly what kind of assistance you are looking for, and how we can best assist you.


If you are a RETURNING CLIENT, please contact SSTB staff for your abbreviated application!


We cannot consider your application unless you provide us with the information requested. 
Please be aware that completing an application does not automatically qualify you for assistance. 





Start Small Think Big is committed to providing access and reasonable accommodation in its services, programs, activities, and employment for individuals with disabilities. To request disability accommodation in the application or intake process, or at any other point in working with us, please contact us at hello@startsmallthinkbig.org or 646-723-4053 for our 
New York City office or (415) 966-2187 for our Bay Area office.

Page 2

Eligibility Policy

Start Small’s mission is to help under resourced individuals build and sustain thriving businesses in order to increase their personal financial security and stimulate economic activity in underserved communities in New York City and the Bay Area.


Entrepreneurs eligible for Start Small assistance must meet ALL of the following criteria:


1.  Location. Eligible entrepreneurs must either live or operate a business that is physically located in one of the five boroughs of New York City OR one of the following counties in California: Alameda, Contra Costa, Santa Clara, San Francisco or San Mateo.


2.  Business stage and Characteristics. You must be currently selling goods/services and have documented sales for the past 3 months in the total amount of at least $500. The business has not raised more than $75,000 in equity capital, including, but not limited to convertible debt, common equity, preferred equity, or SAFE note.  


If your business has not yet begun to conduct sales, Start Small Think Big may still consider your application*, if one of the following conditions are met:

  • If you are purchasing an existing business and have 1) agreed to a purchase price for that business, and 2) have a credible financing plan in place.

  • If you have a proposed commercial lease or vendor contract  in hand.

*Note the submission of  a written, credible plan to begin conducting sales within 12 months will be required.


3. Household financial circumstances and  resources. Household income (including applicant’s share of net business income) must not exceed 500% of the Federal Poverty Guidelines ("FPG"). Please refer to the chart below.  Also, applicant’s household must have less than $50,000 in eligible assets (note: a retirement account balance is not considered an eligible asset).


2018 Federal Poverty Guidelines
2018 FPG Template
Yes No

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Privacy Policy

We will not disclose the information you provide in this Application for Assistance to anyone except:
  1. our employees and representatives, for the purpose of making a determination about whether you qualify for our services and/or for the performance of our services;
  2. as otherwise authorized by you;
  3. as required by law, court order, or regulatory authority; or
  4. we may compile data and information provided by you and other Start Small Think Big applicants and/or clients, but such information will only be disclosed on an aggregate or illustrative basis and will not be disclosed in a manner that would personally identify you.
Yes No
We're sorry, but we cannot proceed with your Application for Assistance unless you consent to both our Eligibility Criteria and our Privacy Policy. If you would like to continue with the Application for Assistance, please press "Previous Page" and click "Yes" to both of these questions.

If you have questions, please contact us at (646) 723-4053 for our New York City office, (415) 966-2187 for our Bay Area office, or hello@startsmallthinkbig.org.

 

Start Small Think Big



Referral Source

If more than one, please select the most influential.

If more than one, please select the most influential.





If you have questions about our application, eligibility policy or privacy policy, or would prefer to complete this Application for Assistance over the phone, please feel free to call us between 9:00am and 5:00pm, Monday through Friday at (646) 723-4053 for our New York City office, (415) 966-2187 for our Bay Area office, or send an email to hello@startsmallthinkbig.org.  

Start Small Think Big
Personal Contact Information










Business Contact Information











IMPORTANT

If your business has more than one ownerEACH owner of the business must complete this Application for Assistance before we will be able to schedule an appointment.

%
Provide the full name of each owner or potential owner of your business (OTHER than yourself):





Consent is required in order to continue.

If you have questions, please contact us at (646) 723-4053 or hello@startsmallthinkbig.org.
 
If you have questions about our application, eligibility policy or privacy policy, or would prefer to complete this Application for Assistance over the phone, please feel free to call us between 9:00am and 5:00pm, Monday through Friday at (646) 723-4053 for our New York City office, (415) 966-2187 for our Bay Area office, or send an email to hello@startsmallthinkbig.org.  

Start Small Think Big
Business Stage




Please click yes if you are currently earning any revenue from your business. Are people paying money for your product or service? Click yes!






Buy-in Business


Business Finances- Annual



If you have questions about our application, eligibility policy or privacy policy, or would prefer to complete this Application for Assistance over the phone, please feel free to call us between 9:00am and 5:00pm, Monday through Friday at (646) 723-4053 for our New York City office, (415) 966-2187 for our Bay Area office, or send an email to hello@startsmallthinkbig.org.  

Start Small Think Big
Who Is In Your Household?




Yes No
Yes No
If you have questions about our application, eligibility policy or privacy policy, or would prefer to complete this Application for Assistance over the phone, please feel free to call us between 9:00am and 5:00pm, Monday through Friday at (646) 723-4053  for our New York City office, (415) 966-2187 for our Bay Area office, or send an email to hello@startsmallthinkbig.org.  
Start Small Think Big

Income Sources- Outside of your Busienss
Directions:
1) Please fill in the following table with the amount of income you or other members of your household receive for each category of income for the current year, for income outside your business.
2) Please report the GROSS amount of income received- before taxes for the current year

Non- Business Annual Employment Income
Annual amount YOU personally receive for the current year:                 Annual amount other members of your household receive for the current year:
Employment (Wages, Salaries, Tips etc.) **from sources other than self-employment in a business you operate
Non- Business Annual Other Income Sources
Annual amount YOU personally receive for the current year:                 Annual amount other members of your household receive for the current year:
Alimony/ Child Support
Pensions/ annuities / distribution from retirement accounts
Return on investment (interest, dividends, rents, royalties, trusts income from estates etc.)
Financial Support from outside the household. 
Other Income Sources:
Non- Business Monthly Employment Income
Monthly amount YOU personally receive for the current year:                 Monthly amount other members of your household receive for the current year:
Employment (Wages, Salaries, Tips etc.)
Non- Business Annual Other Income Sources
Monthly amount YOU personally receive for the current year:                 Monthly amount other members of your household receive for the current year:
Alimony/ Child Support
Pensions/ annuities / distribution from retirement accounts
Return on investment (interest, dividends, rents, royalties, trusts income from estates etc.)
Financial Support from outside the household. 
Other Income Sources:
PUBLIC BENEFITS
Yes No

Public Benefits: Monthly amounts received
Please indicate which of the following public benefits you or members of your household receive, and for those that you receive, please enter the monthly amount received for the current year
Received?      Personal Monthly                           Amount         Household Monthly Amount                       (not including you) 
Unemployment Insurance:
Temporary Assistance for Needy Families:
Women, Infants, and Children (WIC):
Medicaid/Medicare:
Supplemental Nutrition Assistance Program (SNAP)/Food Stamps:
Housing assistance (Section 8/public housing):
Social Security Insurance (SSI) or Social Security Disability Insurance (SSDI):
Other:

Public Benefits: Annual amounts received
Please indicate which of the following public benefits you or members of your household receive, and for those that you receive, please enter the annual amount received for the current year
Received?      Personal Annual                           Amount         Household Annual Amount                                 (not including you) 
Unemployment Insurance:
Temporary Assistance for Needy Families:
Women, Infants, and Children (WIC):
Medicaid/Medicare:
Supplemental Nutrition Assistance Program (SNAP)/Food Stamps:
Housing assistance (Section 8/public housing):
Social Security Insurance (SSI) or Social Security Disability Insurance (SSDI):


HOUSEHOLD ASSETS
In this section we ask about certain Household Assets.  These do not include:
  • The value of the home you live in;
  • The value of up to one car per household;
  • Life insurance;
  • Retirement accounts (e.g., IRAs and 401(k)s);
  • Education assistance (e.g., scholarships and loans).
Total Household Amount:    
TOTAL Value cash on hand, money in checking & savings accounts:
TOTAL value of stocks, bonds, and other investments:  
TOTAL value of non-primary vehicles:
TOTAL value of equity in a vacation home, rental property, other second home:
TOTAL value of other household liquid assets:
Additional Personal Financial Questions







To access your free (non-FICO) credit score, go to creditkarma.com. 
If no Credit Score


If you have questions about our application, eligibility policy or privacy policy, or would prefer to complete this Application for Assistance over the phone, please feel free to call us between 9:00am and 5:00pm, Monday through Friday at (646) 723-4053  for our New York City office, (415) 966-2187 for our Bay Area office, or send an email to hello@startsmallthinkbig.org.  

Start Small Think Big
Employment


Education






If you have questions about our application, eligibility policy or privacy policy, or would prefer to complete this Application for Assistance over the phone, please feel free to call us between 9:00am and 5:00pm, Monday through Friday at (646) 723-4053 for our New York City office, (415) 966-2187 for our Bay Area office, or send an email to hello@startsmallthinkbig.org.  

Start Small Think Big

Business Information




Employees

Do NOT count yourself or anyone else who is an OWNER of the business.






Business Online Presence
If you have questions about our application, eligibility policy or privacy policy, or would prefer to complete this Application for Assistance over the phone, please feel free to call us between 9:00am and 5:00pm, Monday through Friday at (646) 723-4053  for our New York City office, (415) 966-2187 for our Bay Area office, or send an email to hello@startsmallthinkbig.org.  

Start Small Think Big
Thank you for completing Start Small's application. You're almost done!  Just a few questions about the specific kinds of assistance you seek from Start Small Think Big and hit submit below.

 We are excited to meet you!

Legal Assistance Requested




If you have legal issues not related to small business, please see www.lawhelp.org


If you have legal issues not related to small business, please see www.lawhelp.org
Financial Assistance Requested

Market Access Assistance Requested




If you have questions about our application, eligibility policy or privacy policy, or would prefer to complete this Application for Assistance over the phone, please feel free to call us between 9:00am and 5:00pm, Monday through Friday at (646) 723-4053  for our New York City office, (415) 966-2187 for our Bay Area office, or send an email to hello@startsmallthinkbig.org.