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As a non-profit ACE relies on funding from organizations like the SBA and must report demographic information in order to receive this funding. All information is kept confidential and your privacy is very important to us.

Fields marked with a * are required.

Account Login Information

Email Address *

Enter Email

Confirm Email Address *

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Password *

Enter Password

Confirm Password *

Confirm Password

General Information

Name *

First

Last Name *

Last

Phone *

10 digits, numbers only. No dashes, spaces, etc.

Are you currently an ACE Loans Client? (Do you you have a loan with us?) *

Yes

Location Information

Home Address (include Apt/Suite/PO Box if needed) *

City *

State *

Zip/Postal *

County *

How are you employed?

Working in my business (self-employed)

Working for someone else

Not employed (whether seeking or not)

Do you have a business? *

Yes

Business Information

Name of Company *

Legal Entity Structure

Sole Proprietorship

Partnership

LLC

C-Corp

S-Corp

Non-Profit

Other

If other, please tell us the legal structure of your business. *

Date business started. *

Percentage of business ownership that is male. *

Percentage of business ownership that is female. *

Are you 8(a) certified? *

Yes

Are you a home-based business? *

Yes

Do you conduct business online? *

Yes

Number of full-time employees. *

Number of part-time employees. *

Gross revenue/sales for most recent business year. *

Demographic Information

Do you have a disability? *

Yes

I prefer not to answer

What is your gender? *

Female

Male

Transgender Female

Transgender Male

Other

I prefer not to answer

What is your age?

18-29

30-49

50+

Other

Do you have children? *

With Children

Without Children

Other

Are you a veteran? *

Non-Veteran

Veteran

Member of National Guard

Spouse of Military Member

I prefer not to answer

Which of the following best represents your racial heritage? *

Asian

Black or African American

Native American or Alaskan Native

Native Hawaiian or other Pacific Islander

White

I prefer not to answer

Which of the following best represents your ethnic heritage? *

Hispanic Origin

Non-Hispanic

I prefer not to answer

Marital Status: *

Single

Married/Partnered

Divorced

Widowed

I prefer not to answer

Total Household Income

(Round to the nearest $5000)

Number of household members *

Participation Agreement E-Signature

DISCLAIMER: I request business counseling service from Access to Capital for Entrepreneurs an SBA Women’s Business Center and resource partner (ACE). I agree to cooperate should I be selected to participate in surveys designed to evaluate ACE services. I permit/consent SBA/ACE the use of my name and address, photograph, and/or related public information to be used by ACE in education and informational activities such as: newspaper articles, brochures, legislative briefs, and for surveys and information mailings regarding SBA/ACE products and services. I understand that any information disclosed will be held in strict confidence and am authorizing SBA/ACE to furnish relevant information to the assigned management counselor(s) or ACE staff in consideration for furnishing management or technical assistance. I waive all claims against SBA/ACE personnel and host organizations, arising from this assistance. Use of Information: The information in this form is to be provided by individuals and businesses seeking technical assistance services from the SBA/ACE. The information is collected to help SBA/ACE’s continuing improvement of business counseling programs, to ensure effective oversight and management of entrepreneurial development programs and grants, and to meet Congressional and Executive Branch reporting requirements. SBA/ACE will not provide your personal information to commercial entities.

Client E-Signature *

Date *

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