Client Intake Form

Welcome to the Entrepreneurship Center at Community Teamwork Inc.

This form will help us understand your business, your goals, and the type of assistance you need. Based on your responses, our team will connect you with business advising, lending assistance, workshops, or other appropriate resources.

The form should take approximately 3–5 minutes to complete. Your information will be kept confidential and used for program services and reporting purposes.

Client Information

First Name

Last Name

Email Address

Phone Number

Preferred Contact Method

CallTextEmail

Preferred Language

Street Address

If you selected "Other", please describe below:

City

State

Zip Code

Date of Birth (MM/DD/YYYY)

Are you a U.S. Citizen?

YesNo

I agree to receive text messages from the Entrepreneurship Center regarding my request for assistance. Message and data rates may apply.

I certify that the information provided is accurate to the best of my knowledge. I authorize Community Teamwork Inc. to contact me regarding business services, programs, workshops, lending assistance, and appropriate referrals.

Contact Information