Enrollment Form

The information in this form is to be provided by individuals and businesses seeking services from the Entrepreneur Fund. The information is collected to help the Entrepreneur Fund’s continuing improvement of business counseling programs, to ensure effective oversight and management of entrepreneurial development programs and grants, and to meet grant reporting requirements. Any information disclosed will be held in strict confidence. (The Entrepreneur Fund will not provide your personal information to commercial entities.)




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Do you have any revenue and had a grand opening?










The owner is considered 1 full time employee. If this number is less than 1 please indicate you are not in business.


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Business Ownership


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To satisfy program funder requirements, please answer questions below based on last tax year-end information:


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BY SIGNING, I REQUEST SERVICES FROM THE ENTREPRENEUR FUND (EF), A SMALL BUSINESS ADMINISTRATION (SBA) RESOURCE PARTNER:


I understand information disclosed will be held in strict confidence; EF/SBA will not provide personal information to commercial entities.


I agree to participate in program surveys that evaluate EF/SBA services. I authorize EF/SBA to furnish relevant information to assigned staff.


I understand the advising staff will not:


  1. Recommend goods or services from sources he/she has an interest in or
  2. Accept fees or commissions developing from this advising relationship. In consideration of management or technical assistance provided, I waive all claims against EF/SBA and its resource partners and host organizations arising from this assistance.

Information provided is used to report to funders, many who require that the EF serve specific populations. I understand for some programs and services, I will need to furnish EF with personal, household and business income to satisfy funder requirements. I certify that information regarding my income is accurate and complete. I authorize EF to verify the income information provided and share with funders for reporting purposes.


Warning (SBA): Section 1001 of Title 18 of the United States Code (Criminal Code and Criminal Procedure) shall apply to the foregoing certification. Title 18, provides among other things, that whoever, knowingly and willingly makes or uses a document or writing containing any false, fictitious or fraudulent statement or entry, in any manner within the jurisdiction of any department or agency of the United States, shall be fined not more than $10,000 or imprisoned not more than five years, or both.


Note: The estimated burden for completing this form is 18 minutes. You are not required to respond to any collection information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to: US Small Business Administration, 409 3rd St, SW, Washington, DC 20416, and to: Desk Officer SBA, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, DC, 20503. OMB Approval (3245-0324). PLEASE DO NOT SEND FORMS TO OMB.


The Entrepreneur Fund (EF) is an equal opportunity employer, lender, & service provider. EF does not discriminate in providing services on the basis of race, color, religion, sex, national origin, age, marital status, family status, physical or mental disabilities. Reasonable accommodations for people with disabilities or with limited English proficiency are available upon request. Make requests at least 2 weeks in advance by contacting our office at 218-623-5747 or info@entrepreneurfund.org.