Power Up Your Business Peer-based Learning Experience Application

First Name: *

Last Name: *

Name of Company: *

Position with company: *

Position with company: Other... (Please provide your title and responsibilities)

Please provide your title and responsibilities *

Business Address: *

City: *

State: *

Zip Code: *

Home Address: *

City: *

State: *

Zip Code: *

Cell Phone: *

Business Phone: *

Email: *

Business Website: *

Where is your business operating from: *

Where is your business operating from: Other (Please specify)

Is your business location: *

Is your business location: Other (Please specify)

Do you have a Philadelphia Issued Commercial Activity License? *

Please provide your Commercial Activity License Number Here *

Which type of class would you be interested in taking? *

Hybrid - mix of in person and online

Online - meeting via zoom throughout the session

In person only - meeting in one of the college locations (Center City, West Philadelphia, South Philadelphia, North East Philadelphia, and North Philadelphia)

Peer-Based Learning Experience is a 12 week, 36-hour program. Select your preferred cohort date: *

January – April

May – July

August – November

Have you ever participated in any other Power Up Your Business Programs? *

Which program did you participate in? *

If you participated in Peer Based Learning before, please indicate your former business name *

Please specify which series *

Are you interested in other Power Up Your Business Programs? If so which program(s)? *

Yes, Store Owner Series - Workshops for small businesses to help run and manage your business effectively. The workshops are held virtually and in various neighborhoods throughout Philadelphia. 

Yes, Industry Best Practices - Six-part workshops target the unique needs of specific industries, including restaurant, child care, salon and retail. Build resiliency and foster growth in your business. 

Yes, Community Startup Accelerator - Aims to provide entrepreneurs with quality business training, coaching, and technical assistance support to build a sustainable and scalable business model. This program is for any small business owners located in or residing in Philadelphia. 

No – Not at this time.

Business Information

In what industry is your business? *

In what industry is your business? Other...

Type of Organization (select one): *

Type of Organization (select one): Other...

Minority-Owned: *

Women-Owned: *

Veteran Owned *

Immigrant Owned *

LGBTQ Owned *

Ethnicity: *

Is your business currently open and making sales? (Must be open for one year and making some sales to qualify) *

If your business has been open, for how long? *

Do you know what commercial corridor your business is in? *

Do you work full time or part time on your business? *

What were business sales last month? *

What was your reported revenue last year? *

Are you able to pay yourself a salary from the business? *

Do you have anyone else that you pay to help operate the business? *

No. of Full-Time Employees (if applicable): *

No. of Part-Time Employees (if applicable): *

No. of Temporary paid employees (Independent contractors, 1099, etc.) *

Do you have a separate bank account for your business? *

Do you have inventory? *

How much money have you put into the business? *

Have you ever applied for a business loan? *

Have you ever received a business loan? *

Yes

Where have you received a loan from? *

Where have you received a loan from? Other...

Name of Referral *

What do you consider to be the most challenging operations issue in your business today? *

What do you consider to be the most significant opportunity that you have not yet achieved? *

What is Your Primary Business Goal? *

Brief Description of your Business: *

Demographic Information *

Demographic Information Other...

Please note this information is collected for our internal statistical purposes only. The information you provide does NOT have any effect on your eligibility for our program. Please indicate your race or ethnic background. Check All That Apply

Highest level of education completed *

Highest level of education completed Other...

Do you have any prior ownership, managerial or supervisory experience? *

Yes

Do you have any work and/or educational experience directly related to your business? *

Yes

Have you ever declared bankruptcy? *

Yes

Leave this field blank

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Power Up Your Business Peer-based Learning Experience Application

Business Information