Ignite Small Business Program Referral Form

Welcome to the first step in your journey with Ignite Small Business Start Ups. We look forward to working with you to explore your business idea. If you are interested in more information visit our website at www.ignite.ssi.org.au.

Ignite is for people from refugee and migrant communities.
IgniteAbility is for anyone with a disability, their family or carers.
IgniteFirst is for any Australian First Nations entrepreneurs
Ignite Regional is for the anyone in Coffs Harbour and Armidale, (not a refugee, PWD, or Australian First Nations person)
Choose your program that best applies to you.

Program

Program Location

Applicant Details

First name	Middle name
Last name	Preferred Name
Gender	Pronouns
Date of Birth DD/MM/YYYY (30/01/1990)	Mobile number
Email address Please enter ONE email only	Country of origin
Ethnicity	Date of arrival in Australia DD/MM/YYYY (30/01/1990)
Employment status	Visa type
Highest education level achieved	What is your current monthly income?
Language spoken	If Other language:
English language proficiency	Interpreter required?
Are you of Aboriginal and/or Torres Strait Islander origin? Other disability Are you on an NDIS package?	Main type of disability or long-term health condition Describe your level of support needs in everyday living Do you have an NDIS support coordinator?
Is there any other information we need to be aware of when making an appointment with you?

Address in Australia

Address

Street

Suburb

State

Postcode

Emergency Contact Details

Emergency contact name

Emergency contact relationship

Emergency contact phone

Emergency contact address

Business Details

Do you have previous business experience

Do you currently operate the business being referred?

Business Idea (Please Describe)

What role will you have in the business?

Who will you sell your product or service to?

Where will the business operate?

What skills or experience do you have that will make the business a success?

What have you done so far to progress the business idea?

Are there any particular challenges you will need assistance with?

Do you have the required capital to fund the business?

If not, how will you raise the capital?

Overview of your existing business:

What role do you fill in the business ?

Who do you sell your product or service to?

Where does the business operate?

What are your greatest business goals or challenges?

Are there any particular challenges you will need assistance with?

PLEASE NOTE: Ignite is not a financial institution and does not offer business loans. We can connect the entrepreneur to a micro lender.

Referrer Details

Name If self-referring, put your own name	Where did you hear about Ignite Which organisation or program do you work for? Or where did you hear about Ignite?
Office location	Phone number
Referrer email Please enter ONE email only