Register for Counseling

Union Institute & University - Ohio SBDC at the Greater Cincinnati Urban League

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Please answer the following questions regarding your existing or planned business.

First Name
Last Name
Zip Code	Enter your 5 digit Zip Code. If you don't have one or don't know your zip code, enter 00000
Minority Ownership %	% Enter the expected (if preventure) or existing minority ownership percent for this business. (A business is minority-owned if at least 51% or greater of the business or stock is owned by minority individuals and the management and daily operations are controlled by one or more minorities.)
Woman Ownership %	% Enter the expected (if preventure) or existing woman ownership percent for this business. (A business is woman-owned if at least 51% or greater of the business or stock is owned by one or more women and the management and daily operations are controlled by one or more women.)

Business Name	Leave blank if you do not have a name chosen or the business name is the same as your name.
Position	Your position or title related to this business
Business Address	Your physical street address (number and street) of the business. If a home based business, or the business has not started yet, use your home address.
Address Line 2	Optional. Use for additional address postal information like apt, floor, suite, etc., or a PO Box.
City
State

Please enter contact information regarding this business so that we may contact you if necessary

Primary Phone	The best phone number (with area code) to reach you during our standard business hours. Include extension if necessary.
Primary Phone Type	Type of the primary phone above
Secondary Phone	A secondary phone number to contact you, if we cannot reach you at the primary number.
Secondary Phone Type	Type of the secondary phone above

Web Site	Web site URL for the business
Business Description	Brief three to five word description of the business

Please answer the following demographic questions about yourself, or the primary owner if there are multiple business owners. Providing the information in this section is voluntary but will be used by SBA to assess how well the program is serving different communities and to ensure equitable treatment of all people.

Race	White Black Asian Native American/Alaskan Hawaiian/Pacific Check any that apply
Hispanic Ethnicity
Gender
Do you identify as
Do you identify as
Disability	Do you consider yourself a person with a disability
Veteran/Military Status

Business Status

Business has started

Check if you have started conducting business. Leave unchecked if you are in the planning stages and have yet to start this business.

Since this business has started, please enter the following information.

Year Started	Year this business started
Month Started	Month this business started
Business Type	Primary category of business

Business Organization

Legal entity of the business

Employees FT

Current Number of Full Time Employees

Employees PT

Current Number of Part Time Employees

Annual Sales $

Annual Sales $ for the most recent full business year

Annual P/L $

Annual Profit/Loss $ for the most recent full business year

Are you currently exporting

Yes

Export Employees	Current Number of Total Export Related Employees
Export Sales $	Export Related Sales for most recent full business year
Export Countries	Countries you are currently exporting to. Start typing the name of the country and a list will appear to choose from. You may select more than one.

Past SBA Services Received

If you applied for or received any of these SBA services in last 5 years, please check all that apply:

Access to Capital

Accounting/Budget/Inventory

Agribusiness

Business Planning

Business Start-Up

Buy/Sell Business

Cash Flow Analysis & Mgmt

Commercialization

Computer Systems

Customer Relations

Engineering R&D

eVantage

Federal & State Tech. Program

Financial Analysis

Franchising

Government Contracting

Human Resources

Intellectual Property

International Trade

Inventory Control

LEAN

Legal Issues

Management/Leadership

Market Diversification

Marketing Planning

NxLeveL

Other

Regulatory Compliance

Small Business Innovation Rsrc

Strategic Planning

Tax Planning

Technology

Veteran’s Outreach Conference

Women’s Business/Certification

Check any SBA Services received above in the last 5 years, if applicable.

How did you hear about us?
Do you conduct business in a language other than English?	If yes, which language?
Are you requesting language assistance?	If yes, which language?
For assistance you are now seeking, please check all that apply	Access to Capital Accounting/Budget/Inventory Agribusiness Business Planning Business Start-Up Buy/Sell Business Cash Flow Analysis & Mgmt Commercialization Computer Systems COVID-19 Disaster Loan COVID-19 General Support Customer Relations Engineering R&D eVantage Federal & State Tech. Program Financial Analysis Franchising Government Contracting Human Resources Intellectual Property International Trade Intnl. Trade Country Profiles Intnl. Trade Market Research Inventory Control Legal Issues Management/Leadership Market Diversification Marketing Planning Operations Analysis & Planning Other Regulatory Compliance Small Business Innovation Rsrc Strategic Planning Tax Planning Technology Women’s Certification Check all the kinds of assistance above that you now seek
Briefly describe the specific assistance you are requesting
What is the dollar ($) amount of the loan or grant you are requesting, if applicable?

Please read the following, enter your Full Name, and click Continue below to indicate your acceptance.

I request business counseling service from the Ohio Small Business Development Center (SBDC) Network. I acknowledge that the Ohio SBDC Network includes the International Trade Assistance Centers (ITAC) and Manufacturing and Technology Small Business Development Centers (MTSBDC). The Network partner organizations include the U. S. Small Business Administration (SBA), U. S. Department of Commerce's National Institute of Standards and Technology's Manufacturing Extension Partnerships (MEP), SBA's Office of International Trade (OIT), and the Ohio Department of Development (ODOD).

I agree to cooperate should I be selected to participate in surveys designed to evaluate services received from any of the above referenced partners.

I also permit these partners to use my name and address for surveys and information mailings regarding the partners’ products and services.

I understand that any information disclosed will be held in strict confidence. My personal information will not be shared with partners except in aggregate reporting. My personal information will not be provided to commercial entities. I do authorize partners to furnish relevant information to the assigned management counselor(s).

I further understand that the counselor(s) agree not to 1) recommend goods or services from sources in which he/she has an interest; and 2) accept fees or commissions developing from this counseling relationship. In consideration of the counselor(s) furnishing management or technical assistance, I waive all claims against the SBA and other resource partners and host organizations, arising from this assistance.

Please enter your full name, indicating your acceptance of the above terms.

Full Name:

Date: 6/5/2023 12:35:05 PM

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