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Home » Small Business Development Center » Request Business Counseling Form

Counseling is at no cost to you as a business owner. All new clients of the Centenary College Small Business Development Center will be charged a $15.00 administrative service fee. The processing of a new client and a packet of material include: NJSBA Small Business Resource, Start-Up Checklist for Small Businesses, List of Business Websites, BIC Resource Listing, Centenary College SBDC brochure and NJ Business Service Programs.

Thank you and we look forward to working with you further as a business owner.

Request For Counseling Application

PART I: General Contact Information

First Name:

Last Name:

Address:

City

State

Zip Code

Email:

Phone:

Cell:

Fax:

PART II: Demographic Profile

Race:

Are You of Hispanic Origin?

Gender:

Do you consider yourself a person with a disability?

Veteran Status

Military Status

PART III: Business Profile

What inspired you to contact us?

Are you currently in business?

Name of Company:

Business Start date:

Is this a home-based business?

Do you conduct business online?

How many full time employees do you currently have?

How many part time employees do you currently have?

What is the legal entity of your business?

Other entity then listed above:

Type of Business: (choose primary category)

PART IV: Nature of Assistance:

What location do you prefer?

Do you prefer a certain counselor?

Other:

Describe your business/idea in 3 to 5 words:

What kind of assistance do you seek?

Other assistance if not listed above:

PART V: Client Agreement - Electronic Signature

"I request business management counseling from the Small Business Administration resource partner, the New Jersey Small Business Development Center. I agree to cooperate should I be selected to participate in surveys designed to evaluate SBA or SBDC assistance services. I understand that any information received by an SBDC resource counselor will be held in strict confidence by the counselor to the extent allowable by law."

"I further understand that any counselor has agreed: (1) not to recommend goods or services from sources in which he/she has an interest, nor (2) accept fees or commissions developing from this relationship. In consideration of SBA's furnishing management or technical assistance, I agree to waive all claims against SBA personnel, NJSBDC and its host organizations, and other SBA Resource Counselors arising from this assistance."

I, accept this Agreement by typing "I Accept" as my electronic signature below.

Type "I Accept"

A partnership program with the U.S Small Business Administration. Additional funding provided by Centenary College, Hackettstown, NJ. All opinions, conclusions or recommendations expressed are those of the author(s) and do not necessarily reflect the views of the SBA.

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