Business Advisory Program Application
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Hamilton County Office of Small Business
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Contact ID
Campaign ID
Program
The information in this form is to be provided by individuals and business seeking technical assistance services from ECDI, a SBA Resource Partner. The information is collected to help ECDI's continuing improvement of business counseling programs, to ensure effective oversight and management of entrepreneurial development programs and grants, and to meet Congressional and Executive Branch reporting requirements.
Any information disclosed will be held in strict confidence. (ECDI will not provide your personal information to commercial entities.)
Business Owner
First Name
Middle Name
Last Name
Birthdate
Email
Personal Phone
Address
City
County
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Postal Code
Business Owner Demographics
Race
Asian
Black or African American
Native American/Alaska Native
Native Hawaiian/Other Pacific Islander
White
Prefer to Self Describe
Prefer not to say
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Choose Not to Respond
Gender
Male
Female
Non-Binary
Prefer to Self Describe
Household Information
How many adults and children live in your household (including yourself)?
What is your Adjusted Gross Income (combined annual income, including yourself and all members of your household)? (Adjusted gross income is your household’s total gross income minus specific deductions.)
$
Business Information
Are you currently in business?
Yes
No
Legal Name of Business
Business Entity Type
Please select...
Corporation
Limited Liability Company(LLC)
Not yet established
Partnership
S-Corporation
Sole Proprietorship
Other (Specify)
Unknown
LTD
501 C 3
Other Entity Type
Type of Business
Mining
Utilities
Information
Construction
Retail Trade
Manufacturing
Finance & Insurance
Wholesale Trade
Public Administration
Educational Services
Real Estate and Rental and Leasing
Healthcare and Social Assistance
Accommodation and Food Services
Arts, Entertainment and Recreation
Transportation and Warehousing
Professional, Scientific and Technical Services
Management of Companies and Enterprises
Agriculture, Forestry, Fishing and Hunting
Administrative and Support
Waste Management and Remediation Services
Other Services (except Public Administration)
Is Your Business Address Different from the personal address entered above?
Yes
No
Business Address Information
Business Address
City
County
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Postal Code
What is the square footage of the location?
Date of Business Formation
First Year of Tax Filing
Total Number of Full-Time Employees
Total Number of Part-Time Employees
Your Signature (Full Name)
Based on last tax year-end information, what was your Annual Business Revenue?
$
Questions
Has the COVID pandemic negatively impacted your business?
Yes
No
Please explain how.
Please provide documentation of the negative impacts described above.
What do you want to work on with an expert coach? What do you want to achieve?
Do you have reliable access to a tablet?
Yes
No
Do you have reliable access to a computer?
Yes
No
Do you have reliable access to the internet?
Yes
No
Are you a Hamilton County grant recipient?
Yes
No
Grant Recipient Checkbox
Documentation
If you participate in the program, please confirm you are willing to provide requested documentation regarding the size of your business, location, business financials, and proof of negative impact due to COVID if applicable.
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o protect your data, ECDI uses multiple safeguards including multi-factor authentication, server backups, best in class endpoint detection and response software to ensure your information is safe.
Contact Information