Small Business Growth Program: Prospective Client Application
Title within company:
LinkedIn (if applicable):
Address of company headquarters (Street Address, City, State, ZIP):
How long has your company been in business?
Less than 1 year
5 years or longer
Please give your best estimate of your company's revenue last year.
Less than $100,000
$100,000 to $250,000
$250,000 to $500,000
$500,000 to $750,000
$750,000 to $1 million
Greater than $1 million
Which of these best describes the scope of your business?
Primarily serve customers in 1 or 2 neighborhoods
Serve customers throughout Chicago
Serve customers throughout Chicago and the suburbs
Serve customers throughout the Midwest
Serve customers nationwide
Please briefly identify your industry, describe your organization, and, importantly, provide
about your typical customers, your products and services, and other details that would help us understand your business.
Please indicate if your business is 50% or more owned by any of the following: (Please select all that apply)
Minorities/A Minority Individual
None of the above
If your company has any minority or disadvantaged business certifications, please list them below.
If your company has a website, please indicate the URL below.
Please define your growth goals for this current year and for the next two years? What would ideal growth look like for your business? (Please write between 50 and 200 words.)
Please describe the business issues that are driving your interest in an Innovation and Growth project with our program? (Please write between 50 and 200 words.)
Please describe the business decision(s) you hope to make for which the results of this project would be an input? What is the one critical question that you desire to answer? (Please write between 50 and 200 words.)
How did you find out about this program?
Please use this space to raise any questions or comments or clarify any of the above responses (Optional):
Thank you for your responses! Please click the "Submit" button below to record your responses. The Polsky Exchange will reach out to the most qualified applicants within the next 1 to 2 weeks.
Please direct any questions to Kristin Barrett at
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