The Gayle and Bill Cook Center for Entrepreneurship Application for Business Consulting
BASIC INFORMATION ———————————————————————————————————————

First Name      Last Name

Address
City     State      Zip

Phone (Primary)    Phone (Cell)

Email

Would you like to have your email address added to the Cook Center mailing list to receive information about local events and resources for entrepreneurs?
Yes
No

Website URL

Student Status:
Ivy Tech Student
Former Ivy Tech Student
Entrepreneurship Ivy Tech Student
Not A Student

Business Ownership Type:
Female
Veteran
Minority
Disabled

Who referred you to the Cook Center?
Advertising
Chamber
Educational Institution
Local Economic Development
Newspaper
SCORE

Bank:
Word of Mouth
Internet
TV or radio
SBA/SBDC
Other:


BUSINESS INFORMATION
——————————————————————————————————

Business Status:
Pre-Venture/Idea Stage
Business Plan Completed
Start-Up (in business < 1 year)
In Business (in business > 1 year)

Company Name
Company Email (same as above)
Company Phone
(same as primary)       (same as cell)

Industry Type:
Agriculture
Finance
Research & Development
Service

Construction
Manufacturing
Retail
Other:

Date Company Started

Total Employees:
Full-Time      Part-Time

Gross Revenue/Sales      +Profits / -Losses

What is the legal entity of your business?
Corporation
LLC
Non-profit
Partnership
Sole Proprietorship
S-Corporation
None of the Above

What type of business help are you looking for?
Accounting/Records
Computer Systems
Engineering R&D
Franchising
Government Contracting
International Trade
Getting Started
Liquidation
E-commerce
Financing/Capital
Marketing/Sales
Personnel
Patents/Copyrights
Sources of Capital
Other:

Please explain your business/business idea and describe the most important needs for your business.