The Gayle & Bill Cook Center for Entrepreneurship

Application for Business Consulting

Thank you for reaching out to the Gayle & Bill Cook Center for Entrepreneurship for your small business needs. By now you are well on your way to starting or growing your own business. If you are a new client and have not viewed our introductory page, please find it at ivytech.edu/bloomington/entrepreneurship and view the attached video before applying for assistance. Once you have done this, please click on “Application for Business Consulting” and complete the application form. If you are unable to answer a particular question or are unsure of an answer, it is ok to leave an answer blank. The more information we have as to your background and needs, the better we may assist you.

The strategy behind this information is to be able to define where you are with your business and to understand your business goals. This information will help us track your progress in the long run and allow us to get you to the right resource or information quickly and efficiently. All of the information that is collected in the application is completely confidential. The Gayle & Bill Cook Center for Entrepreneurship adheres to strict confidentiality and conflict of interest policies.

Please complete the form as accurately and completely as possible. The more specific information you can share, the better we can evaluate your needs and help you to the right information quickly. If you have any questions, please contact our office at (812)330-6261.

Thanks again for reaching out to the Gayle & Bill Cook Center for Entrepreneurship and we look forward to helping you with your immediate and future business needs.

BASIC INFORMATION ———————————————————————————————————————

First Name      Last Name

Address
City     State      Zip

Phone (Primary)    Phone (Cell)

Email

Website URL

Student Status:
Ivy Tech Student
Former Ivy Tech Student
Entrepreneurship Ivy Tech Student
Not A Student

Business Ownership Type:
Female
Veteran
Minority
Disabled

Who referred you to the Cook Center?
Advertising
Chamber
Educational Institution
Local Economic Development
Newspaper
SCORE

Bank:
Word of Mouth
Internet
TV or radio
SBA/SBDC
Other:


BUSINESS INFORMATION
——————————————————————————————————

Business Status:
Pre-Venture/Idea Stage
Business Plan Completed
Start-Up (in business < 1 year)
In Business (in business > 1 year)

Company Name
Company Email (same as above)
Company Phone
(same as primary)       (same as cell)

Industry Type:
Agriculture
Finance
Research & Development
Service

Construction
Manufacturing
Retail
Other:

Date Company Started

Total Employees:
Full-Time      Part-Time

Gross Revenue/Sales      +Profits / -Losses

Company NAICS or SIC Number

What is the legal entity of your business?
Corporation
LLC
Non-profit
Partnership
Sole Proprietorship
S-Corporation
None of the Above

What type of business help are you looking for?
Accounting/Records
Computer Systems
Engineering R&D
Franchising
Government Contracting
International Trade
Getting Started
Liquidation
E-commerce
Financing/Capital
Marketing/Sales
Personnel
Patents/Copyrights
Sources of Capital
Other:

Please explain your business/business idea and describe the most important needs for your business.


The Gayle & Bill Cook Center for Entrepreneurship adheres to strict confidentiality and conflict of interest policies.