Application Form

Full Name *

Email *

Phone *

Home Address *

State *

City *

Zip Code *

Are you currently in business or are you thinking about starting a business? *

Describe the business that you have or the idea for the one you want to start: *

Where do you need help the most? *

Are you committed to attending all 6 Saturdays of the Entrepreneur Pathway for Urban Communities program? *

The program fee is $495. Would you like to be considered for a $475 scholarship? *

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