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Momentum Financial Academy for Microenterprise: Application Form

  1. Instructions
    Please fill out this form as completely as possible, and sign and date the bottom of the form. Incomplete or invalid information will not be processed.
  2. Part A: Business Information
  3. Are you already in business and being paid for your product or service?*
  4. Is the business registered with the NC Secretary of State?*
  5. For home-based businesses, enter the home address

  6. Enter the best phone number to reach the applicant

  7. Are you a certified Minority- or Woman-Owned Business Enterprise (MWBE)?*
  8. How many employees do you have (including yourself)?*
  9. Part B: Financial Information

    This information will be kept completely confidential, and will only be used to determine eligibility.

  10. Have you received funding for your business within the past year?*
  11. If yes, please select the type(s) of funding you received
  12. What was the business' annual revenue in 2021?*
  13. What was the business' annual net profit in 2021?*
  14. How many people live in your household?*
  15. What was your annual household income for the 2021 tax year?*
  16. Please upload your 2021 tax form 1040, or another 2021 tax form that confirms annual income

  17. Do you pay yourself?*
  18. Do you currently use an accounting system for maintaining your business financial records?*
  19. If yes, please select the type(s) of accounting system
  20. Part C: Additional Information
  21. Part D: Agreement and Signature

    Applicants must attend 4 weeks (twice weekly) of a small business course held online via Zoom, so reliable access to a computer with Internet connection is required. Each class is 2 hours long and will be held on Tuesday and Thursday mornings from 8am - 10am. By submitting this form, I am agreeing that, if selected, I am able to attend 100% of these Tuesday and Thursday classes.

  22. Type applicant initials.

  23. Receive an email copy of this form.
  24. This field is not part of the form submission.
  25. Leave This Blank:

  26. This field is not part of the form submission.