1445 Market Street
Denver, CO 80202
Phone: 303-620-8076
Fax: 303-534-2145

NxLeveL Entrepreneurial Training Program Regsitration Form

NOTE: Fields marked in RED are required.

Name:
Daytime Phone:
Address:
City:
State:
Zip:
Email:
Gender: Male Female
Age:
Ethnic Background:

African-American
Asian-American
Native-American
Caucasian
Hispanic
Other

Education: Elementary/Secondary School
Some vocation/trade
Some college
4-year college graduate
High school graduate
Vocational/trade school graduate
2-year college graduate
Post graduate
Have you previously owned-operated a business? Yes No
What is / will be the main activity of your business?
Length of operation / managing a business:
Description of business: Idea for potential business
Part-time business
Start-up business (less than 2 years old)
Expanding a business (more than 2 years old)
Including yourself, how many people does your business presently employ? Number of part-time employees:
Number of full-time employees:
If this is a new venture, how soon do you want to be in business? 0-3 Months
3-6 Months
6-12 Months
more than a year
Gross sales revenue from last year:
Which location are you applying for:

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