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META Pre-enrollment Form
After completing this pre-enrollment form, META will contact you to schedule a free 30-minute appointment. During this free consultation, you'll find out more about who we are and how we've helped other entrepreneurs like you to start, strengthen, or expand their businesses. We'll find out about you and your current business needs.
If we mutually agree that it's a good fit, we start the enrollment process and enter your information into our database so we can track your progress! There is a one-time enrollment fee of $35. Once paid, you will not be charged for future one-one-one consultations from our team. Want to learn more about the advantages of becoming a META client? Our team is ready to help. Complete the form below and let's meet!
Participant First Name:
Participant Middle Initial:
Participant Last Name:
Enrollment Date (META staff completes):
Today's Date:
Participant ID Number (META staff completes):
SS #:
Grant(s) assigned (META staff completes):
Street Address:
City:
State:
Zip:
County:
Email Address:
Telephone:
Location:
Urban
Suburban
Rural
Date of Birth:
Marital Status:
Single / Divorced
Married / Domestic Partner
Gender:
Male
Female
What is your current job status (including self-employment)?:
Full time
Part time
Unemployed
Education level completed:
8 years or less
9-12 years
13-17 years
18 years
Have you ever owned a business/been self-employed in the United States?:
No
Yes
Have you had previous part-time work experience in the U.S.?:
No
Yes
Have you had previous full-time work experience in the U.S.?:
No
Yes
Marital Status:
Married
Never Married
Separated/Widowed/Divorced
Number of Adults in Household (including participant):
Number of Adult Children in Household:
Number of Minor Children in Household:
Ethnicity:
African-American
Asian/Pacific Islander
Hispanic
Caucasian
Native American
Unknown
Cambodia
Hmong
Sudan
Afganistan
Cuba
Iran
Thaidam
Albania
Armenia
Bosnia
Burma
Eritrea
Ethiopia
Former Soviet Union
Haiti
Iraq
Laos
Liberia
Somalia
Tibet
Uganda
Vietnam
Other
If applicable, date of entry into the United States:
Level of English language competency:
Not applicable
None
Little
Conversational
Proficient
Total household monthly gross income:
Are you receiving TANF?:
No
Yes
Are you receiving other Cash Assistance? (GA, GR, SSI, TCA, etc.)?:
No
Yes
Are you now receiving Food Stamps?:
No
Yes
Are you requesting assistance to:
Expand a business
Start a business
Stabilize a business
Are you now receiving Housing Assistance?:
No
Yes
Do you have an Individual Development Account (IDA)?:
No
Yes
Please enter the characters to the right:
Submit
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