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Learn How to Handle CHRO Discrimination Complaints
(
*
Denotes Required Fields)
Personal Information
First Name:
*
Last Name:
*
Your Title:
Address:
Address 2:
City:
*
State:
*
Zip:
*
Primary Email:
*
Work Phone:
Mobile Phone:
Home Phone:
Demographic Information
We request the information that follows to satisfy reporting requirements of our grant funders. Please help us better describe our impact and the communities we serve. (Your information will be used in aggregate totals only.)
What is your gender?:
Male
Female
Non-Binary
Other
Prefer not to answer
The state of Connecticut defines low and moderate income as those with household income (AGI) below $112,600. Do you consider yourself to be part of this group?:
Yes
No
Prefer not to respond
Race:
Asian
Black or African American
White
Native -- American or Alaskan
Native Hawaiian or Pacific Islander
Prefer not to respond
Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
Prefer not to respond
Do you consider yourself a person with a disability?:
Yes
No
Prefer not to respond
Current military status:
Not in the military
On Active Duty
In the Reserve or National Guard
Spouse of a member of the military
Prefer not to respond
Military Veteran status:
Not a Veteran
Veteran
Service-disabled Veteran
Spouse of a Veteran
Prefer not to respond
Select one:
I am a current CEDF client
I am a small business owner but not a CEDF client
I am interested in small business education topics but not a business owner
About your Business
If you are not currently in business for yourself you may skip to the acknowledgement section below.
Date business started:
Business name:
Business Address:
Business Address 2:
City:
State:
Zip:
% of female ownership:
Exporting?:
Yes
No
Prefer not to respond
Annual sales:
Form of organization:
Sole Proprietor
Limited Liability Company (LLC)
S-Corporation
C-Corporation
Other
Business industry:
Manufacturing
Technology
Construction
Healthcare
Retail
Service
Other
Jobs in your business: Include yourself, other owner(s), full-time and part-time employees and independent contractors. (Total people):
Acknowledgement
By typing my full name in the box below I agree that CEDF may use my information collected above for the stated purposes. Our organizations will send you future announcements of educational programs, for which you may opt out of at any time.
Signature:
I want to stay updated on this and other business education programming offerings.
Not sure which loan or educational service meets your need?
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888-835-2333
or
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