[email protected]
1-218-461-1722
Main Menu
Home
Programs
Healthy Place
Pursue Housing
Micro-Enterprise
Growing Kinship Connection
Resources
Resources
Careers
Media
Volunteer
Training & Development
Donate Now
Main Menu
Home
Programs
Healthy Place
Pursue Housing
Micro-Enterprise
Growing Kinship Connection
Resources
Resources
Careers
Media
Volunteer
Training & Development
Donate
Intake Form - Micro Enterprise
How Did You Hear About Our Program?
Name
First
Middle
Last
Date of Birth
Month
Day
Year
Preferred Mailing Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Email
Employer
Tribal Affiliation
Religion
Race
African-American/Black
American Indian
Asian/Pacific Islander
Two or More Races
Unknown/Declined
White
When Will You Be Available for a Meeting?
Do You Feel Comfortable Meeting Virtually in Person or Over the Telephone?
Virtually In Person
Over The Phone
Other
Please Describe
Explain in a Few Words What Services You Need?
How Many Steps Have You Already Taken?
Have You Created a Business Plan? (If So, Please Send Attachment With Intake Form)
What Is Your Gross Annual Income? (Proof of Income May Be Required)
Attachment
Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.
