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Question 1
1
BLDG Memphis is conducting data collection with the Small Business Administration (SBA) to measure the growth of small businesses in targeted Memphis neighborhoods. This intake form will be used to further connect small businesses to community resources. The information provided will ONLY be used for data collection purposes.
I request business counseling service from the Small Business Administration (SBA) or Community Navigator. I understand that any information disclosed will be held in strict confidence. (SBA will not provide your personal information to commercial entities.) I authorize SBA to furnish relevant information to the assigned management counselor(s). I further understand that the counselor(s) agrees 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 SBA personnel, and that of its Community Navigator and host organizations, arising from this assistance.
Yes, I agree.
(NOTE: Participation in intake is voluntary.)
This question is required.
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Key
A
I accept
Key
B
I don’t accept
Question 2
2
First name, last name
This question is required.
*