HSBA Application Provider

Section 1: Applicant Information

1.1. Business Name:

1.2. Business Address (Principal Place of Business in Henderson):

Address Line 1

Address Line 2

City

State

Zip Code

1.3. Business Structure (Sole Proprietorship, LLC, Partnership, Corporation)

Sole Proprietorship
LLC
Corporation

1.4 Applicants Name:

First

Last

Title:

1.6 Business Phone:

1.7 Email Address:

1.8 Website (if applicable):

Section 2: Business Overview

2.1. Type of Business (e.g., finance, marketing, e-commerce, etc.):

Finance
Marketing
E-Commerce
Other

2.2 Is your business a non-profit?

Yes
No

2.3 Briefly describe your business (products, services, mission, etc.):

2.4 How many years has your business been operating in Henderson?

2.5 Annual Revenue (approximate):

2020

2021

2022

2.6 How many employees do you have?

Full-Time Employee(s)

Part-Time Employee(s)

1099/Contractor(s)

2.7 Is your business minority-owned, woman-owned, or veteran-owned?

Yes
No

Section 3: Deserving Provider Questions

3.1 Why do you believe your consulting services are well-suited to be a provider for the HSBA Program? Please describe the unique qualities or circumstances that make your business stand out. (Max 300 words)

3.2 How does your business actively engage with the local community or contribute to the betterment of the City of Henderson? This may include participation in community events, support for local charities, job creation, or any other activities that positively impact the city. (Max 200 words)

Section 4: Commitment to Mentorship

4.1 Describe your business's commitment to fostering economic growth and job creation within the City of Henderson. (Max 200 words)

4.2 Describe your commitment to actively engage with and implement guidance to small business owners (Max 200 words)

4.3 How do you envision the mentorship contributing to the growth and success of your business in Henderson? (Max 200 words)

Section 5: Additional Information

5.1 Have you previously participated in any mentorship/consulting programs?

Yes
No

If you answered yes above, please provide details:

5.2 How did you hear about the HSBA Program?