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BCFR Small Business Client Intake Form
Thank you for your interest in
Battle Creek Food Reimagined (BCFR
) Small Business Support Hub (SBSH) Programs. This application will help us determine which support services you are eligible for. For more information regarding The Small Business Support Hub Programs:
Click here
We will contact you on next steps via email. Thank you! If you have questions or need assistance, please contact Battle Creek Food Reimagined at
bcfrmarketing@bcfood.org
Company name
*
Registered Business Name (as listed on your LARA ID, if applicable), "TBA" if startup
Street address
*
City
*
State/Region
*
Zip code
*
Business County
*
First name
*
Last name
*
Email
*
Re-enter Email
*
Phone number
*
Description
*
Brief description of company.
Website URL
Year Established
*
If start up or in process just enter current year
NAICS Code
*
If none, enter "N/A". Find your 6-digit code here:
https://www.naics.com/search/
Interested in exploring and pursuing a new business idea?
New Business Idea, if so select yes.
Please Select
Yes
No
Is this a New Business?
New Business (formed within the past 12 months)
Please Select
Yes
No
Is this an "early stage" business?
Startup/Early Stage (formed within 0-3 years)
Please Select
Yes
No
Is this a microbusiness?
Microbusiness (Business has 10 or fewer FTEs)
Please Select
Yes
No
Is this a "second stage" business?
Second Stage Business (Business has 10 or more FTEs & 1 million or more in annual revenue)
Please Select
Yes
No
LARA ID Number
*
If not applicable enter "NA". Link for LARA ID: https://cofs.lara.state.mi.us/SearchApi/Search/Search
Date Registered in LARA
https://cofs.lara.state.mi.us/SearchApi/Search/Search
Month
/
Day
/
Year
Date of Initial Intake
*
Date filled out
Month
/
Day
/
Year
Current number of employees
*
Enter "0" if not established yet
Projected FTEs Created
Indicate the number of current Full Time Equivalent/Employee (FTE) Jobs
What type of support services are you looking for?
Access to facilities and equipment
Events, networking, and referrals
Research and development and commercialization support
Financing support activities
Mentoring, coaching and training
Other (ex. other support services to help your business grow)
How was the business impacted by COVID
Please Select
My business experienced loss in revenue and/or incremental expenses due to COVID-19
My business had to shut down or reduce hours during COVID-19
My business had to lay off staff due to COVID-19
Does not apply to me
Other
If you selected "Other" in the previous question regarding reasons for being impacted by COVID-19, please briefly explain your situation below.
Demographic Information. Please select all that apply:
A tribal entity refers to an organization or governing body that represents a Native American tribe recognized by the federal government.
Tribal Entity
Minority-owned or controlled business status
*
A "Minority Owned Business" means a business that is at least 51% owned by the following individuals or, in the case of a publicly owned business, at least 51% of the stock is owned by one or more of the following individuals (i.e., the management and daily operations are controlled by those minority group members):
(a) Asian Pacific - A U.S. citizen whose origins are from the Asian Pacific region. These countries include the following: Cambodia; China; Guam; Japan; Korea; Laos; Malaysia; the Philippines; Samoa; Thailand; Tibet; Taiwan; the U.S. Trust Territories of the Pacific or the Northern Marianas; and, Vietnam.
(b) Hispanic -A U.S. citizen of true-born Hispanic heritage, from any of the Spanish-speaking areas of the following regions: Argentina, Belize, Bolivia, Brazil, Central America, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, South America, Uruguay, Venezuela.
(c) Asian Indian - A U.S. citizen whose origins are from the Asian Indian region. These countries include Bangladesh; India; Indonesia; Nepal; Pakistan; Sri Lanka.
(d) Black / African - A U.S. citizen having origins in any of the Black racial groups of Sub-Sahara Africa. These countries include Angola; Benin; Botswana; Burkina-Faso; Burundi; Cameroon; Cape Verde; Central African Republic; Chad; Comoros; Democratic Republic of Congo (DRC); Cote d’Ivoire; Djibouti; Equatorial Guinea; Eritrea; Ethiopia; Gabon; Gambia; Ghana; Guinea; Guinea-Bissau; Kenya; Lesotho; Liberia; Madagascar; Malawi; Mali; Mauritania; Mauritius; Mozambique; Namibia; Niger; Nigeria; Rwanda; Sao Tome &Principe; Senegal; Seychelles; Sierra Leone; Somalia; South Africa; Swaziland; Tanzania; Togo; Uganda; Western Sahara; Zambia; and Zimbabwe.
(e) Native American - A person who is an American Indian, Eskimo, Aleut or Native Hawaiian, and regarded as such by the community of which the person claims to be a part.
(f) Middle East / North African - A U.S citizen whose origins are from the Middle East or North Africa such as; Iran, Iraq, Saudi Arabia, Turkey, Algeria, Egypt, Morocco, Libya or Syria.
Please Select
Yes
No
Prefer not to respond
Women-owned or controlled business status
*
Please Select
Yes
No
Prefer not to respond
Do you identify as a member of the LGBTQIA+ ( lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual) community?
Please Select
Yes
No
Prefer not to say
Is company a Veteran-owned or controlled business?
*
Please Select
Yes
No
Prefer not to say
Is this company a disabled-owned or controlled business?
*
Please Select
Yes
No
Prefer not to respond
Yes, I want to receive newsletter updates
Please Select
Yes
No
BCFR Client Information Release Form
*
The Michigan Economic Development Corporation (MEDC) funded the BCFR Small Business Support Hub Programs. As part of providing SBSH services, BCFR and its partners are required to share the Company's information with the MEDC for reporting purposes. the Company agrees as follows:
AGREEMENT
1.The Company understands and consents to this information sharing.
2.The Company acknowledges that the BCFR does not endorse, verify or express an opinion regarding the Company’s Business Information, including whether the Business Information satisfies any applicable state or federal laws.
3.The Company agrees that the BCFR is not responsible for any outcome resulting from the BCFR and MEDC sharing Business Information.
4.The Company agrees to release, defend, hold harmless and indemnify the BCFR and its affiliates and successors from all claims, causes of action, or any other demands that may arise from the BCFR and MEDC sharing Business Information.
5.The Company agrees that the laws of Michigan govern this Agreement. The Company represents that an authorized representative of the Company has executed this Agreement with full authority and approval of the Company. Please check the box below before submitting.
I have read and agree to the terms of the above documents
Please Select
I agree
Submit