Pathway WBC Business Assessment

U.S. Small Business Administration: Counseling Information Form

Pathway WBC is funded in part through a Cooperative Agreement with the U.S. Small Business Administration. In order for us to better serve you, please take a few minutes to fill out this Self-Assessment Form.

If you have any questions, please call Pathway WBC staff at (615) 425-7171.

We look forward to working with you!

 

641 Self Assessment
First
First
I agree to cooperate should I be selected to participate in surveys designed to evaluate SBA services. I permit SBA or its agent the use of my name and address for SBA surveys and information mailings regarding SBA products and services. 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 Resource Partners and host organizations, arising from this assistance. Please note: The estimated burden for completing this form is 18 minutes. You are not required to respond to any collection information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to: U.S. Small Business Administration, 409 3rd Street, SW, Washington, DC 20416, and to: Desk Officer SBA, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C., 20503. OMB Approval (3245-0324). PLEASE DO NOT SEND FORMS TO OMB.

PART II: Client Intake (to be completed by all Clients)

What percentage of your company is female owned?
What month and year did you start your business?
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