Application for Assistance

Start Small Think Big provides free small business legal assistance and financial consulting to qualified entrepreneurs and small business owners. This application helps us determine whether you qualify for our services. It also helps us to determine exactly what kind of assistance you are looking for, and how we can best assist you.

If you are a RETURNING CLIENT, please contact SSTB staff for your abbreviated application!

We cannot consider your application unless you provide us with the information requested.

Please be aware that completing an application does not automatically qualify you for assistance.

Start Small Think Big is committed to providing access and reasonable accommodation in its services, programs, activities, and employment for individuals with disabilities. To request disability accommodation in the application or intake process, or at any other point in working with us, please contact us at hello@startsmallthinkbig.org or 646-723-4053 for our

New York City office or (415) 966-2187 for our Bay Area office.

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Eligibility Policy

Start Small’s mission is to help under resourced individuals build and sustain thriving businesses in order to increase their personal financial security and stimulate economic activity in underserved communities in New York City and the Bay Area.

Entrepreneurs eligible for Start Small assistance must meet ALL of the following criteria:

1. Location. Eligible entrepreneurs must either live or operate a business that is physically located in one of the five boroughs of New York City OR one of the following counties in California: Alameda, Contra Costa, Santa Clara, San Francisco or San Mateo.

2. Business stage and Characteristics. You must be currently selling goods/services and have documented sales for the past 3 months in the total amount of at least $500. The business has not raised more than $75,000 in equity capital, including, but not limited to convertible debt, common equity, preferred equity, or SAFE note.

If your business has not yet begun to conduct sales, Start Small Think Big may still consider your application*, if one of the following conditions are met:

If you are purchasing an existing business and have 1) agreed to a purchase price for that business, and 2) have a credible financing plan in place.
If you have a proposed commercial lease or vendor contract in hand.

*Note the submission of a written, credible plan to begin conducting sales within 12 months will be required.

3. Household financial circumstances and resources. Household income (including applicant’s share of net business income) must not exceed 500% of the Federal Poverty Guidelines ("FPG"). Please refer to the chart below. Also, applicant’s household must have less than $50,000 in eligible assets (note: a retirement account balance is not considered an eligible asset).

2018 Federal Poverty Guidelines

	Yes	No
I understand Start Small Think Big's Eligibility Criteria:

Which office are you applying to?

New York CityBay Area

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Privacy Policy

We will not disclose the information you provide in this Application for Assistance to anyone except:

our employees and representatives, for the purpose of making a determination about whether you qualify for our services and/or for the performance of our services;
as otherwise authorized by you;
as required by law, court order, or regulatory authority; or
we may compile data and information provided by you and other Start Small Think Big applicants and/or clients, but such information will only be disclosed on an aggregate or illustrative basis and will not be disclosed in a manner that would personally identify you.

	Yes	No
I understand and accept Start Small Think Big's Privacy Policy.

We're sorry, but we cannot proceed with your Application for Assistance unless you consent to both our Eligibility Criteria and our Privacy Policy. If you would like to continue with the Application for Assistance, please press "Previous Page" and click "Yes" to both of these questions.

If you have questions, please contact us at (646) 723-4053 for our New York City office, (415) 966-2187 for our Bay Area office, or hello@startsmallthinkbig.org.

Who Is In Your Household?

Does another person claim you as a dependent ?

Yes.No.

Does another person provide you with more than half of your living expenses?

Yes.No.

Who is this person?

My spouse or domestic partnerParentsAnother Person

NOT including yourself, how many people does this person claim in his or her household?

What is your marital status?

	Yes	No
Do you have any dependent children (under the age of 18) or children whom you provide with more than half of their financial support (regardless of whether they live with you or not)?

How many dependent children (age 17 or younger) do you have?

	Yes	No
Are there any adults (age 18 or older) who are your dependents or whom you provide with more than half of their financial support (regardless of whether they live with you or not)?

How many dependent adults (age 18 or older) do you have?

If you have questions about our application, eligibility policy or privacy policy, or would prefer to complete this Application for Assistance over the phone, please feel free to call us between 9:00am and 5:00pm, Monday through Friday at (646) 723-4053 for our New York City office, (415) 966-2187 for our Bay Area office, or send an email to hello@startsmallthinkbig.org.

Total Number of People in Household

Income Sources- Outside of your Busienss

Directions:

1) Please fill in the following table with the amount of income you or other members of your household receive for each category of income for the current year, for income outside your business.

2) Please report the GROSS amount of income received- before taxes for the current year.

What time period would you prefer to use to report your income?

I will report the monthly amount received by me/ my household.I will report the annual amount received by me/ my household.

Non- Business Annual Employment Income

	Annual amount YOU personally receive for the current year:	Annual amount other members of your household receive for the current year:
Employment (Wages, Salaries, Tips etc.) **from sources other than self-employment in a business you operate

Non- Business Annual Other Income Sources

	Annual amount YOU personally receive for the current year:	Annual amount other members of your household receive for the current year:
Alimony/ Child Support
Pensions/ annuities / distribution from retirement accounts
Return on investment (interest, dividends, rents, royalties, trusts income from estates etc.)
Financial Support from outside the household.
Other Income Sources:

Non- Business Monthly Employment Income

	Monthly amount YOU personally receive for the current year:	Monthly amount other members of your household receive for the current year:
Employment (Wages, Salaries, Tips etc.)

Non- Business Annual Other Income Sources

	Monthly amount YOU personally receive for the current year:	Monthly amount other members of your household receive for the current year:
Alimony/ Child Support
Pensions/ annuities / distribution from retirement accounts
Return on investment (interest, dividends, rents, royalties, trusts income from estates etc.)
Financial Support from outside the household.
Other Income Sources:

Total Personal Income

Total Household Income:

PUBLIC BENEFITS

	Yes	No
Do you, or any of your household members, receive public benefits?

What time period would you prefer to use to report your income from public benefits?

I will report the monthly amount received by me/ my household.I will report the annual amount received by me/ my household.

Public Benefits: Monthly amounts received

Please indicate which of the following public benefits you or members of your household receive, and for those that you receive, please enter the monthly amount received for the current year:

	Received?	Personal Monthly Amount	Household Monthly Amount (not including you)
Unemployment Insurance:	Yes
Temporary Assistance for Needy Families:	Yes
Women, Infants, and Children (WIC):	Yes
Medicaid/Medicare:	Yes
Supplemental Nutrition Assistance Program (SNAP)/Food Stamps:	Yes
Housing assistance (Section 8/public housing):	Yes
Social Security Insurance (SSI) or Social Security Disability Insurance (SSDI):	Yes
Other:	Yes

What other Public Benefits do you receive:

Public Benefits: Annual amounts received

Please indicate which of the following public benefits you or members of your household receive, and for those that you receive, please enter the annual amount received for the current year:

	Received?	Personal Annual Amount	Household Annual Amount (not including you)
Unemployment Insurance:	Yes
Temporary Assistance for Needy Families:	Yes
Women, Infants, and Children (WIC):	Yes
Medicaid/Medicare:	Yes
Supplemental Nutrition Assistance Program (SNAP)/Food Stamps:	Yes
Housing assistance (Section 8/public housing):	Yes
Social Security Insurance (SSI) or Social Security Disability Insurance (SSDI):	Yes

Total Personal Income from Public Benefits

Total Household Income from Public Benefits

HOUSEHOLD ASSETS

In this section we ask about certain Household Assets. These do not include:

The value of the home you live in;
The value of up to one car per household;
Life insurance;
Retirement accounts (e.g., IRAs and 401(k)s);
Education assistance (e.g., scholarships and loans).

	Total Household Amount:
TOTAL Value cash on hand, money in checking & savings accounts:
TOTAL value of stocks, bonds, and other investments:
TOTAL value of non-primary vehicles:
TOTAL value of equity in a vacation home, rental property, other second home:
TOTAL value of other household liquid assets:

Total Household Assets:

If you have questions about our application, eligibility policy or privacy policy, or would prefer to complete this Application for Assistance over the phone, please feel free to call us between 9:00am and 5:00pm, Monday through Friday at (646) 723-4053 for our New York City office, (415) 966-2187 for our Bay Area office, or send an email to hello@startsmallthinkbig.org.

Thank you so much for completing the Start Small application. We are excited to start working with you! Please expect to hear back from our intake team typically within 3 business days.