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SSBCI Technical Assistance Program
Intake Form

The Indiana Economic Development Corporation (IEDC) has partnered with Technical Assistance Providers around the state to provide personalized counseling and training for Indiana-based Very Small Businesses (VSBs) and socially and economically disadvantaged (SEDI)-owned businesses to prepare these businesses to complete competitive applications to receive State Small Business Credit Initiative (SSBCI) or other state, federal, and jurisdictional funding opportunities. Indiana’s SSBCI programs seek to empower Hoosier entrepreneurs, startups, and small businesses. To apply for Technical Assistance, please fill out this form to ensure your business is qualified to participate and provide a bit of information to match you with a technical assistance provider.

Company Information

Date Business Started*
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You may find your 6 digit NAICS code by going to their website. 
If awarded SSBCI funds, or state/federal capital program funds, what will the capital be used for?
ex: Managing recently acquired capital, acquiring SSBCI loan, acquiring state and/or federal program funding
Desired Assistance Type*
Does your business identify as SEDI-owned under one of the definitions below?*
(1) Self-certified the business is owned and controlled by individuals who have had their access to credit on reasonable terms diminished as compared to others in comparable economic circumstances, due to their:

     a. membership of a group that has been subjected to racial or ethnic prejudice or cultural bias within American society

     b. gender

     c. veteran status

     d. limited English proficiency

     e. disability

     f. long-term residence in an environment isolated from the mainstream of American society

     g. membership of a Federally or state-recognized Indian Tribe -long-term residence in a rural community

     h. residence in a U.S. territory -residence in a community undergoing economic transitions (including communities impacted by the shift towards a netzero economy or deindustrialization)

     i. membership of an “underserved community” as defined in Executive Order 13985

          i. individuals who belong to communities of color, such as Black and African American, Hispanic and Latino, Native American, Alaska Native and Indigenous, Asian American, Native Hawaiian and Pacific Islander, Middle Eastern, and North African persons

          ii. individuals who belong to communities that face discrimination based on sex, sexual orientation, and gender identity (including lesbian, gay, bisexual, transgender, queer, gender non-conforming, and non-binary (LGBTQ+) persons)

          iii. persons who face discrimination based on pregnancy or pregnancy-related conditions

          iv. Parents

          v. Caregivers

          vi. individuals who belong to communities that face discrimination based on their religion or disability

          vii. first-generation professionals or first-generation college students

          viii. individuals with limited English proficiency

          ix. Immigrants

          x. individuals who belong to communities that may face employment barriers based on older age or former incarceration

          xi. individuals who belong to communities that may face employment barriers based on older age or former incarceration

          xii. persons who live in rural areas

          xiii. veterans and military spouses

          xiv. persons otherwise adversely affected by persistent poverty, discrimination, or inequality.

(2) Self-certified the business is owned and controlled by individuals whose residences are in CDFI Investment Areas, as defined in 12 C.F.R. § 1805.201(b)(3)(ii). Visit https://www.cdfifund.gov/cims to quickly determine if your residence is in a CDFI Investment Area.

(3) Self-certified the business will build, open, or operate a location in a CDFI Investment Area, as defined in 12 C.F.R. § 1805.201(b)(3)(ii)

(4) Self-certified the business is located in a CDFI Investment Area, as defined in 12 C.F.R. § 1805.201(b)(3)(ii)

Point of Contact Information

Disclaimer:

As a SSBCI Technical Assistance program user, we'd like to advise you of certain rights and responsibilities you have as one of our program participants:

You have a right to expect:

  • All information shared with the IEDC and its technical assistance providers and any of its resources (staff, faculty, volunteers, and consultants) will be held in strictest confidence. No information provided by you will be used to the commercial advantage of any staff member, consultant, or other resource of the IEDC or to the benefit of any third party.
  • That your status with the SSBCI Technical Assistance program will remain confidential. No public use of your name, address, or business identity will be made without your prior approval. Please note, however, that the IEDC’s SSBCI programming is by the U.S. Department of Treasury, so limited information with respect to your program usage is provided to the IEDC and the U.S. Department of Treasury for reporting purposes.

The SSBCI Technical Assistance program was created to counsel, train, and assist small business owners in preparing to access or pay back capital obtained from SSBCI or other federal, state, or jurisdictional sources. We will not make business decisions or judgments for you, though we will make recommendations and suggestions as appropriate. These will be based upon our best efforts to apply the experience and resources available to us to assist you in making your own business decisions.

No recommendations will be made as to the purchase of goods or services from any individual or firm with whom any IEDC staff or its vendors have any financial, familial or personal interest.

The counseling and training services provided to you are a part of the effort of the IEDC through its State Small Business Credit Initiative Technical Assistance programming funded by the U.S. Department of Treasury. These services are not intended to compete with, replace, or be a substitute for services available from the private sector.

In consideration of the IEDC furnishing you with management and technical assistance, you agree to waive all claims against the Indiana Economic Development Corporation and its vendors, or any other resources employed by or used in connection with these services. You will also be expected to cooperate with the IEDC in its efforts to assure the quality and effectiveness of the counseling and training services it provides.

In this respect, the IEDC will ask all businesses who receive assistance through the program to complete an evaluation of the services provided. In addition, all businesses will be asked to complete an Intake Form that documents the assistance provided by the IEDC. Finally, clients may receive direct inquiries from this office, the vendor, or the U.S. Department of Treasury with respect to the services provided to you. Your response to all of these inquiries will be greatly appreciated.

Request for Assistance

I request business counseling and/or training services from the Indiana Economic Development Corporation. I agree to cooperate should I be selected to participate in surveys designed to evaluate program services. I permit the IEDC the use of my name, business address, and email address for surveys and information mailings regarding the program. I certify that I am not presently debarred, suspended, proposed for debarment, or declared ineligible or voluntarily excluded from covered transactions by any federal department or agency. I understand that any information disclosed will be held in strict confidence. I authorize the IEDC to furnish relevant information to the assigned technical assistance provider(s). I attest that the above information is complete and accurate.

I further understand that the technical service provider(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 technical assistance provider(s) furnishing management or technical assistance, I waive all claims against IEDC and Technical Assistance program vendors, and that of its Resource Partners and management organizations, arising from this assistance.