Registration Form If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required Name * Email Address * Phone * Mailing Address * City * State * Zip Code * What are you interested in attending? * Gender Male Female Not selected Race/Ethnicity (this helps E4E to focus outreach) No answer Asian Black/African-American Caucasian Hispanic/Latino Native American or Alaska Native Native Hawaiian or Pacific Islander Other Based on last year's Federal tax return, what was your annual Adjusted Gross Income? (Enterprise for Equity is only able to serve people with limited incomes; your answer will determine your eligibility, and you will be asked to provide proof of income.) * $0-$22,311 $22,312-$30,044 $30,045-$37,777 $37,778-$45,510 $45,511-$53,243 $53,244-$60,976 $60,977-$68,709 $68,710-$76,442 How many people live in your household (including you)? * 1 2 3 4 5 6 7 8 9 10 or more Click here if you are receiving unemployment benefits? Are you currently self-employed or interested in self-employment? * Yes No Please briefly describe your business idea. Do you currently have a business? What experience do you have in this business? What types of services have you offered or products have you sold? Have you been paid for these services or products? Yes No How many years have you been in business? less than 1 1-5 6-10 11 or more How did you hear about us? Enterprise for Equity strives to do all we can to support our participants in their learning. Do you consider yourself to have a disability? No Yes If so, what is your disability? Are you currently a DVR (Division of Vocational Rehabilitation) customer? * Yes No What accommodations might you need to participate in our program? Would you like to receive the Enterprise for Equity email newsletter? Yes No Spam Prevention 4 + 7 = * NOTE: Submitting this form will not automatically register you for an Orientation! An E4E staff member will contact you to arrange an appointment.