Marketing & Branding Registration Form

Hidden

In SalesForce?

Please Read Prior to Starting the Application

Welcome to Mountain BizWorks! We are excited you have decided to take your business concept or idea to the next stage by engaging learning tools provided through our Foundations class.

Prior to filling out this application, please note that if you plan to apply for a scholarship to receive a discount on classes, workshops, and some free business coaching hours, you will be REQUIRED to upload Identification (a government issued photo ID) AND Proof of Income (ex. recent tax document or 2 pay stubs).

Name*

(Please include your preferred nickname in parentheses, if applicable)

First Last

Address*

Street Address City State ZIP Code

County (Example- Buncombe)*

Email*

Phone*

Do you want to receive text notifications?

Yes
No

Date of Birth*

Gender*

Ethnicity*

Primary Language*

Do you identify as a single parent?*

Current Military Status*

Please list any Western North Carolina community college, college or university you've graduated from

Your Business*

Please describe the business idea or concept that you would like to work with during the course. It will be important to enter the course with a starting point concept. (max 255 characters)

Industry*

Please choose the description that best fits your business.

Is your business currently operating?*

Yes
No

Business Name*

Business Web Address

Year Founded*

Business Mailing Address

Street Address City State ZIP Code

Business Physical Address

Physical address is same as mailing address

Business Physical Address

Street Address City State ZIP Code

Course Registration Preference

Course Start Date*

Please select your preferred class start date.

Virtual Marketing & Branding Thursdays starting Oct 10; 9:30am – 12:00pm

Course Pricing and Scholarship Info

The course fee is $100. Acceptable forms of payment include cash, check, and credit card. Acceptable forms of payment include cash, check, and credit card. There are a limited number of partial scholarships available for participants who qualify for assistance. These partial scholarships are awarded on a first come, first served basis. Please complete the scholarship section below to apply. We offer a household discount to participants who will be joining the virtual class as a team. Please register each participant individually and note in the scholarship application that you are interested in this discount. If you are a prospective or existing loan client, you are eligible for a scholarship. If you have not already provided your lender with your photo ID and household income, please fill out the scholarship application below.

Are you actively pursuing or have a loan with Mountain Bizworks?*

Yes
No

Have you already been awarded a scholarship?*

Yes
No

Scholarship applicatiom*

Would you like to complete the financial-need based scholarship application?

How would you like to pay for the course?*

Debit or Credit Card
Check
Cash

Payment Details

Marketing & Branding*

Total

$0.00

Credit Card

Card Details

Cardholder Name

Scholarship Application

Mountain BizWorks and our funding partners strive to expand access to our services through offering financial-need based scholarships as current support allows. Please answer the following questions to the best of your ability and note these expectations of our scholarship awardees: 1) you'll need to provide documentation verifying your income level - see below; and 2) you'll agree to participate in an annual impact survey. Your information will be kept strictly confidential by Mountain BizWorks and, if required, by our scholarship funding partner. Please contact us if you need any assistance in completing the application.

Total Household Income*

Please enter the dollar amount of adjusted gross income as reported on your most recent tax return. If you share finances with a spouse and file separately, please report the combined income total.

Hidden

Projected Total Household Income for 2022

Please enter a number greater than or equal to 1.

Total # of people supported by this income including yourself.*

Please enter a number greater than or equal to 1.

Business EIN or SSN*

Please enter a number greater than or equal to 1.

Additional Financial Situation Details

Please use this space to optionally provide any additional details on your current financial situation that may help clarify any of the answers above or otherwise help us consider your scholarship request.

Proof of Income & Identification*

Proof of income and identification is required to process your application. You may attach it below (fastest), email it to scholarship@mountainbizworks.org, or bring it by the office. Acceptable proof of income includes A) most recent tax filing (first page only), B) most recent W-2, C) 2 consecutive paystubs, or D) other documentation deemed sufficient by MBW staff to verify the income reported above.

Documentation is attached below
I'm emailing it to scholarship@mountainbizworks.org today

Please note that we cannot review your application or reserve your seat until we receive the required proof of income, photo ID, & Business EIN or SSN.*

Understood. I'll get them in ASAP.

File Upload for Proof of Income

Drop files here or

Max. file size: 1 MB, Max. files: 4.

File Upload for Photo ID

Drop files here or

Max. file size: 1 MB, Max. files: 4.

Scholarship Certification*

Please enter your initials below to certify that the information provided herein is accurate and complete to the best of your knowledge.

Almost done...

Hidden

Do you need additional technological support before this virtual class begins?*

Technology utilized in Financial Series: Zoom video conferencing application, Slack, Google Drive; and Email.

No thanks! I'm pretty tech-savvy
Yes, please connect me with support

How did you hear about this class?

Word of Mouth
Mountain BizWorks
Local Economic Development Organization
Web Search
Social Media
Outreach Event
Catalyst Fund
Other

Anything Else?

Any other comment or question regarding this registration submission? We would like to know if you have any special class needs such as a disability that could affect your mobility or learning, or if you know you have to miss a certain class date, etc.

Refund Policy

Class registration requires payment in full on or before the first day of class. If you have paid for a class and must cancel your registration, you may choose to hold a credit or receive a refund according to the following: a) Cancel more than 1 week prior to class start date: 100% refund b) Cancel within 1 week of class start date: 75% refund c) Cancel on or after class start date: No refund. Credit in the full dollar amount for use with a future Marketing class, must be used within 6 months of original class date.

By submitting my registration, I certify that everything above is accurate and true to the best of my knowledge. I understand that I will receive the Mountain BizWorks newsletter via email, and I can unsubscribe at any time.

CAPTCHA