Community Economic Development Fund

My Business Jump Start 2023

Please complete the registration information below.  You will receive a screen display and an email with instructions for connecting with the Jump Start course on the My Own Business Institute website.

Further details on the Citizen's Bank Jump Start 2023 competition will be provided by email later.

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(* 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?:
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?:
Race:
Ethnicity:
Do you consider yourself a person with a disability?:
Current military status:
Military Veteran status:
Select one:
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?:
Annual sales:
Form of organization:
Business industry:
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:

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