Tallahassee SBEP Class X Spring 2019 Application

General Information
Class *
First Name *
Middle Name
Last Name *
Title or Position *
Birth Date	/ / (mm/dd/yyyy)
Highest Education Level *
Race/Ethnicity
Gender *
Personal Contact Information
Email Address *
Phone *
Phone Type *
Home Address 1
Home City
Home State
Home Zip Code
Business Information
Business Name (DBA) *
Legal Business Name (if different)
Phone2 *
Phone Type 2 *
Address 1 *
Address 2
City *
State *
Zip Code *
Address Type *
Website *
Business type/industry *
Describe your business: *
Business founded (yyyy) *
Your Percent Ownership *
Legal Entity of Business *
If "Other", please specify
Are you the business founder? *
Is this a family business? *
Do you conduct any business online? *
Is this a home-based business? *
Does your business export? *
2018 Full-time Employees (#) *
2018 Part-time Employees (#) *
2018 Contract Employees (#) *
2017 Gross Revenue *
2017 Profit/Loss *
Annual Personal Compensation *
Social Media
Please provide links to your personal social media pages.
www.facebook.com/
www.instagram.com/
www.linkedin.com/in/
www.twitter.com/
Work Experience
Please list your prior two positions in reverse chronological order, starting with your most recent position.
Name of Company *
Title or Position *
From-to (Year) *
_
Name of Company
Title or Position
From-to (Year)
Narrative
Please describe your role and the critical decisions in which you are involved.
Role and Decisions *
What are your most important business goals for the next five years?
Business Goals *
Please describe the personal objectives you hope to achieve through participation in the SBEP and how they relate to the needs of your business.
Personal Objectives *
Do you have any concerns about participation in the Small Business Executive Program?
Concerns *
How did you hear about the program? *
Separate from this program, the Jim Moran Institute offers exclusive programs for FSU alumni and military veterans. For informational purposes only:
Have you attended Florida State University?
Are you a Veteran?
Are you an immediate family member of a Veteran?
By submitting this application, I acknowledge that attendance and participation in all sessions is mandatory. In addition, I consent to allow the Jim Moran Institute to use all photographs and videos taken at this event in future marketing efforts.
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General Information

Personal Contact Information

Business Information

Social Media

Work Experience

Narrative

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