Start Small Think Big Online Application 3.0

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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. 

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.

Before beginning, please review Start Small Think Big's eligibility policy and privacy policy by clicking "Next Page" below.


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.  

Page 2

Eligibility Policy
  1.  Business stage
  • You must be currently selling goods/services and have reoccurring sales for each of the past 3 months in the total amount of at least $500; OR 
  • be ready to launch a new business and have a proposed commercial lease in hand; OR 
  • be ready to launch a new business and have a proposed vendor contract in hand; OR 
  • seek to purchase an existing business and have already agreed to a purchase price with the seller and have a credible financing plan in place for how you will pay the purchase price.

2.  Household financial circumstances and  resources. Combination of all household income from all sources together with 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).

 

3.    Community impact. Business owners with household incomes between 300-500% of FPG must also show community impact in order to be eligible. By "community impact," we mean the potential for the business to stimulate economic activity in a high-poverty and/or underserved communities in New York City and the Bay Area, such as by creating or maintaining local employment or providing goods and/or services responsive to local needs.


4.  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 the counties of San Francisco or Alameda, in California.


2017 Federal Poverty Guidelines
2017 Federal Poverty Guidelines
Yes No

Page 3

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

Household Financial Resources
Start Small Think Big's mission is to provide free professional legal and financial services to entrepreneurs and small business owners who could not afford or otherwise access them, which includes many low- and moderate-income households. The professionals who volunteer their time with Start Small Think Big rely on us to make a determination that the clients we refer to them are eligible for pro bono services.

In this section, we will ask questions about your personal and household's financial resources.
Income Sources
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
2) Please report the GROSS amount of income received- before taxes for the current year
3) If you or your household do not receive an income source, please leave the field blank.
4) You can select if you would prefer to report your income as an annual or monthly amount.


Annual 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
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:
Monthly 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.)
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:
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.  

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