TA Intake

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Technical Assistance Application

Please answer the following questions so that our Technical Assistance team can assess your business' needs. All responses are confidential under LEAF's Confidentiality Policy. Note that it is mandatory to fill out this form before our initial meeting. Thank you for your cooperation!

Language

Contact Details






Other Personal Information

Completing the following information will allow us to serve you in compliance with the agreements with our funders. Please note that your responses will not affect your eligibility to participate in our programs.





We request household income data on behalf of our grantors. For information about how to calculate household income, please refer to the IRS’s guidelines in the link.












Business Attributes

Please enter the legal name of your business.

Type "N/A" if the business has not been established




Which sector does your business operate in?











Location



Primary Business Location





Secondary Business Location





Please let us know at which address we may reach you.




Owner and Employee Information











For further explanation, please click here










This number includes seasonal employees.
Technical Assistance 




Confidence
Please rate your confidence in the following areas:
Very ConfidentModerately ConfidentSomewhat ConfidentSlightly ConfidentNot ConfidentN/A
Below is a list of common services that LEAF provides to small businesses. Check all that apply to your business, but don't worry if you're not sure!




Datos Personales






Otros Datos Personales

Completar la siguiente información nos permitirá atenderlo en cumplimiento de los acuerdos con nuestros proveedores de fondos. Tenga en cuenta que sus respuestas no afectarán su elegibilidad para participar en nuestros programas.





Solicitamos datos de ingresos familiares en nombre de nuestros donantes. Para obtener información sobre cómo calcular los ingresos familiares, consulte las pautas del IRS en el enlace.












Datos del Negocio






En cuál sector opera su negocio?











Ubicación



Ubicación principal





Ubicación Secundaria





Por favor déjenos saber en qué dirección le podemos contactar.




Datos demográficos de los dueños










Por más información, cliquee aquí.










Incluye labor temporal.

Asistencia Técnica




Confianza
Por favor indique su confianza en los campos siguientes:
Mucha confianza
Confianza moderada
Media confianza
Poca confianza
No tengo confianza
N/A
Abajo hay una lista de servicios típicos que ofrece LEAF.  Marque cualquier que quiere para su negocio, pero no se preocupe si no esté seguro de lo que quiere.







LEAF's Elevate Small Business program is funded in part through a Cooperative Agreement with the U.S. Small Business Administration. We also want to thank Santander, Mass Growth Capital Corporation, and Wells Fargo for their support.
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Contact Information