Enrollment Form

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The information in this form is to be provided by individuals and businesses seeking services from the Entrepreneur Fund.


We collect this information to improve business counseling programs and ensure effective oversight and management of entrepreneurial development programs and grants. Additionally, it is necessary for us to meet grant reporting requirements.

All information disclosed will be held in strict confidence. We do not provide your personal information to commercial entities.





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(Adjusted gross income is your household’s total gross income minus specific deductions.)


Please provide the name of the organization and/or person who referred you


Have you generated any revenue. legally formed your business entity and had a grand opening?












The owner is considered 1 full time employee. If this number is less than 1 please indicate you are not in business.


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Please add all other legal business owners and their percentage of ownership to equal 100%

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Other Partner Information


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Sole proprietors and most LLCs are not considered employee-owned unless they have set up a trust, stock option plan, or similar arrangement.




To satisfy program funder requirements, please answer questions below based on last tax year-end information:


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This enrollment form is provided by the Entrepreneur Fund staff member below.

This form is for your use only and is not to be forwarded to anyone else unless approved by the EFund staff member below.


BY SIGNING WITH A TYPED SIGNATURE AND SIGNATURE DATE BELOW, I REQUEST SERVICES FROM THE ENTREPRENEUR FUND (EFund), A SMALL BUSINESS ADMINISTRATION (SBA) RESOURCE PARTNER:


I understand information disclosed will be held in strict confidence; EFund/SBA will not provide personal information to commercial entities.


I understand that if I do not agree to provide my signature I can close this form and in doing so decline to provide a signature. I understand that a signature is required before I can begin receiving services with EFund.


I agree to participate in program surveys that evaluate EFund/SBA services. I authorize EFund/SBA to furnish relevant information to assigned staff.


I understand the advising staff will not:


  1. Recommend goods or services from sources he/she has an interest in or
  2. Accept fees or commissions developing from this advising relationship. In consideration of management or technical assistance provided, I waive all claims against EFund/SBA and its resource partners and host organizations arising from this assistance.

Information provided is used to report to funders, many who require that the EFund serve specific populations. I understand for some programs and services, I will need to furnish EFund with personal, household and business income to satisfy funder requirements. I certify that information regarding my income is accurate and complete. I authorize EFund to verify the income information provided and share with funders for reporting purposes.


Warning (SBA): Section 1001 of Title 18 of the United States Code (Criminal Code and Criminal Procedure) shall apply to the foregoing certification. Title 18, provides among other things, that whoever, knowingly and willingly makes or uses a document or writing containing any false, fictitious or fraudulent statement or entry, in any manner within the jurisdiction of any department or agency of the United States, shall be fined not more than $10,000 or imprisoned not more than five years, or both.


Note: The estimated burden for completing this form is 18 minutes. You are not required to respond to any collection information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to: US Small Business Administration, 409 3rd St, SW, Washington, DC 20416, and to: Desk Officer SBA, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, DC, 20503. OMB Approval (3245-0324). PLEASE DO NOT SEND FORMS TO OMB.


The Entrepreneur Fund (EFund) is an equal opportunity employer, lender, & service provider. EFund does not discriminate in providing services on the basis of race, color, religion, sex, national origin, age, marital status, family status, physical or mental disabilities. Reasonable accommodations for people with disabilities or with limited English proficiency are available upon request. Make requests at least 2 weeks in advance by contacting our office at 218-623-5747 or info@efund.org.




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