Welcome to the WWBIC! WWBIC is the statewide leading economic development organization. We open doors of opportunity by providing individuals who are interested in starting, strengthening or expanding businesses with access to critical resources such as responsible financial products and quality business and personal finance training.

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WWBIC is a nonprofit 501(c)(3) organization that relies on public and private funding to support economic development efforts throughout the State of Wisconsin. Your personal information is considered confidential and is not released to a third party. Collective data is used strictly for reporting purposes for the benefit of WWBIC.

This secure form is hosted by Formsite. You will be redirected to WWBIC's website after completing the form: www.wwbic.com

A. Client Information

Today's Date * +

Legal Business Name

Doing Business As (DBA) - if different than legal business name

Legal First Name (no nicknames) *

Nickname (ex. Joe for Joseph)

MI

Last Name *

Date of Birth *

Email Address *

Marital Status (please choose one): *

City *

State *

Zip *

Home Address: No P.O. Boxes. If homeless, please write "no address." *

Is your mailing address different than your home address? If yes, please provide below:

Yes

No No

County *

Cell Phone | Ex: "414-555-1212." Write "no cell" if you don't have a cell phone. *

Home Phone (Optional). Ex "414-555-1212"

Work Phone (Optional). Ex: "414-555-1212"

B. Demographic Information

WWBIC collects information because we are asked to report demographic collective data to our funders. Your personal information is considered confidential and is not released to a third party. Collective data is used strictly for reporting purposes for the benefit of WWBIC.

RACE/ETHNICITY/LANGUAGE

What is your race? (please check one): *

What is your ethnicity? (please choose one) *

Hispanic/Latino/Spanish Origin

Not of Hispanic/Latino/Spanish Origin

Prefer not to say

What language are you most comfortable speaking? (please check one): *

What is your sex? (please choose one) *

Female

Male Male

VETERAN STATUS

What is your current veteran status? (please choose one) *

What is your current military status? (please choose one) *

What is your military branch?

What is your current or highest military rank? (please choose one)

DISABILITY STATUS

Do you consider yourself a person with a disability? (please choose one) *

Yes

No

Prefer not to say

HOUSEHOLD INFORMATION

Are you a head of household*? (please check one)
*You must be A) unmarried AND B) provide at least 50% of household income for yourself and dependents or other qualified individuals *

Yes

No

Unknown

INCLUDING YOURSELF, how many ADULTS live in your household? *

How many CHILDREN (under age 18) live in your household? *

EDUCATION & TRAINING

What was the highest grade level you completed in school? (please choose one) *

Have you received any training related to starting a business? *

Yes

No

FINANCIAL & JOB INFORMATION

Does your household currently receive any of the following assistance? (please check all that apply)? *

If you chose "other" above, please list here:

Please estimate your household's annual before-tax income - Because we are a government funded organization, we are required to verify the income of the clients we serve. This information is used for secure recordkeeping and reporting purposes only. *

Annual income $ Annual income $

Is there someone else in your household earning income (spouse, partner, adult child, or other roommate)*?
*Not including children or retired individuals *

Yes

No

Is there another adult in your household that is currently unemployed (spouse, partner, adult child, or other roommate)*? *Not including children or retired individuals
*

Yes

No

WWBIC PROGRAMS

How did you hear about your program? (Check all that apply) *

EMPLOYMENT & SELF-EMPLOYMENT

What is your current employment status? (please choose one) *

Which of the following best describes your current self-employment situation? (please choose one) *

a) Not Applicable - Not seeking self-employment

b) Thinking about starting a business

c) In the process of starting a business but have made no sales

d) Have opened a business and made sales within the past 12 months

e) Have been in business with sales for more than 12 months

Prefer not to say