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NC GATE Scholarship Application

Welcome to the Growing America Through Entrepreneurship (GATE) Application.  The information collected in this application packet will be kept completely confidential and used only for research and training purposes. You need to complete the entire packet. Your answers are important to help improve Project GATE.

You must view the Orientation Video before submitting your application packet.  Please read the following statement and indicate that you have viewed the Orientation Video.

I have viewed the North Carolina Project GATE orientation video in its entirety. I am aware of the benefits and the risks of self-employment as they are outlined in the video.  I have an understanding of the GATE scholarship program and the services that I may receive if I am awarded the scholarship. View the orientation video
Orientation: *

Program Eligibility

To receive self-employment and training services under the GATE program, one must meet certain eligibility requirements:

-At least 18 years of age when you apply
-Meet WIA Dislocated Worker program eligibilty criteria
-Plan to start a business in one of North Carolina's 85 counties (see map below)
-Intend to be self-employed within 12 months.

The map below shows North Carolina's rural counties in blue:
Rural N.C. Counties
Please indicate Yes or No to the following criteria:
As of today, I am at least 18 years old. *
I plan to start a business in one of North Carolina's 85 rural counties. *
I intend to start (or grow) a business within the next 12 months. *
To be eligible for the GATE scholarship, you must certify that you meet the Workforce Investment Act (WIA) dislocated worker eligiblity criteria.  The easiest way to learn more about eligibility is to contact your local JobLink Career Center.  If you would like to see the eligibility criteria, click here for more information.
 * 🛈

Background Information

                                         Month          Day              Year
Sex: *

Rural County Information

North Carolina's Project GATE is funded to serve rural areas in North Carolina.  If you live out of state or in an urban county in North Carolina, you may still participate in project GATE if you meet one of the criteria below: *
Rural N.C. Counties

Background Information Continued

* Where do you plan to locate your business?  If your business will be based out of your home list your home location.

Background Information Continued

Please indicate your race/ethnicity: *
What is your primary language? *
 

Living Situation

What is your marital status right now? *
Do you have any disability or serious health problem that makes it difficult for you to work? *

Employment History

Have you ever been employed full time? *
INSTRUCTIONS:  In the space below, please provide the name, address, phone number, and annual salary of your current and/or previous jobs.
What are you doing now?   (mark all that apply) *
 
Have you ever been self-employed (owned your own business)? *

Self-Employment - Continued

Would you say your most recent business was/is a financial success? *

Unemployment Information

When did your last full time job end?
Why did you stop working at this job? (mark all that apply) *
 
Are you currently receiving Unemployment Insurance benefits? *
 +

Support

How supportive is your family in your attempt to start or grow a business? *
Have you previously received counseling from a Small Business Center at a North Carolina community college? If yes, please provide the name in the provided field? *
 
Have you ever had a credit card, line of credit, bank loan, or other form of credit history? *
Do you have any problems with your credit history? *
Do you currently have... *
 YesNo
Health insurance coverage?
A working car?
A working telephone?
Easy access to a computer?
A bank account?

Relative/Friend Contact Information

INSTRUCTIONS:  In the space below, please provide the name, address, and phone number of three close relatives or friends who are likely to know how to contact you if your contact information changes.  We will only contact these people if we have trouble contacting you directly.  Please complete all three boxes if possible.

1.  Contact information for first relative or friend:

GATE Consent Form

The Growing America Through Entrepreneurship program is operated by the North Carolina Rural Economic Development Center in partnership with the North Carolina Community College System’s Small Business Center Network. Each client of the GATE program will also enroll as a client of the Small Business Center Network, and these two agencies will work together on behalf of the client. GATE services will be offered to eligible applicants as program resources and funding allows.

GATE staff will ask you to provide information about the business you may start as a result of participating in the program. By accepting the GATE scholarship, you agree to an "open books" policy with your GATE counselor for up to one year after your participation has ended. You will be asked to share periodic financial statements and business impacts for counseling and evaluation purposes.

As a client of the GATE program and the Small Business Center Network, your personal and business information will be kept in strict confidence and will not be shared unless the law requires disclosure or you request otherwise in writing. As a GATE client, your consent to release information is required for the following routine program operations: 

  1. GATE program staff may share your information with training institutions and support organizations to authorize enrollment, registration, scholarship payments or make other arrangements on your behalf.
  2. GATE program staff may consult or make referrals to outside resources and support organizations on your behalf. You participation the GATE program counseling process may require staff to communicate with partnering agencies and organizations to garner resources or information for your benefit.
  3. The GATE program is publicly funded, and from time to time, requires program evaluation and impact analysis. Your information may be shared with a third party evaluation or research organization for these purposes, however, none of your individual information will be published or made public without your consent.
 *

Thank you for applying for Growing America Through Entrepreneurship!

[pipe:10] [pipe:23],

Your application has been received and you will be notified via email of your eligibility in 7-10 business days.
Congratulations for being selected to participate in New Generation Ventures. Your Startup counselor is looking forward to working with you, but first we need more information about you, your business, and your finances.  The purpose of the following assessment is to review your current skills and situation.  Please evaluate yourself honestly as this helps your Startup counselor develop a training and assistance plan for your next steps in starting your own business.  Review the information below.
Running your own business is not for everyone.  A Business owner must be willing to make sacrifices both personally and finacially to build a successful business.  The following questions ask you to rate your personal traits.  Answer the following questions with Strongly Disagree (1), Disagree (2), Indifferent (3), Agree (4), or Strongly Agree (5).
 *
 Strongly Disagree (1)Disagree (2)Indifferent (3)Agree (4)Strongly Agree (5)
I view failure as a learning experience and am not too discouraged by it.
I'm willing to take risks based on my own abilities.
I enjoy situations which require my initiative and depend on me for their success or failure.
I would start my own business even if I could make twice the money working for someone else.
I get uptight in uncertain situations.
I am a self-starter who is self-reliant.
I enjoy routine and repetitive tasks.
I don’t mind working long nights and weekends.
I have the discipline to see a job through to its end.
I constantly see business opportunities all around me.
I enjoy networking, meeting and talking with people who might help me with my business.
I have trouble managing my time.

Business Idea

Note:  The GATE scholarship provides free training in idea identification and the hands-on development of a business plan.
Do you have a business idea? *
Below please give us some details on the business you'd like to start.  If you do not have a business idea at this point please answer these questions to the best of  your ability in a general sense.

Business Idea

Have you ever operated a business similar to the one you propose to start or grow? *
Will your new business build on skills or knowledge you developed while working for someone else? *
The following questions ask you to rate yourself in reference to several general business skills.  Please indicate your level of ability as well as whether you'd like to receive training in that skill.
General Business Skills
 *
 I'm good at this (1)I'm OK at this (2)I'm NOT OK at this (3)I am Interested in Training
Business Plan Writing
Sales/Marketing
Customer Service
Organizational Skills
Record Keeping
Financial Analysis
Above you indicated your apptitude in several general business skills that are relevant across diciplines.  Below please let us know about your skills that are specific to your chosen industry which you either have or are in need of. For example trade skills, hobbies, or skills obtained via your educational career that might help in your future business.
Starting a new business can be a strain on individual and family finances.  Fincancial freedom might  be your ultimate goal in deciding to open your own business; but you must keep in mind most startup businesses take six months or longer to start making a profit.  The following questions will cover your and your family's fincancial situation and management.
1. Do you have a spouse, significant other, family member, or a friend that is willing to support you financially while you are building your business? If Yes, please note the relationship of that individual in the field provided. *
 
2. Do you have another source of income that will continue for at least the next 6-12 months? (ex. part time job, unemployment or disability benefits, workman's compensation, etc.) If Yes, please describe in the field provided. *
 
3. Do you have savings or other funds that you could invest in the business? *
4. Are you able to pay your bills on time right now? *
5. Do you keep a personal budget- a record of your income and expenses? *
6. Do you carry a balance on your credit card(s) from month to month? *
Please rate your credit history below, based on your current knowledge.  If no credit history is established please indicate that below as well.
               Good Credit                   Needs Improvement                    Poor Credit
 __10____9____8____7____6____5____4____3____2____1__
Rating
If you have not done so in the past six months, please obtain a copy of your credit report using the instructions provided below (and NOT one of the commercial services you might have seen on TV). It is critical that both you and your coach have this information as this will be an indicator of your ability to borrow money for your new business. It is up to you to decide if you want to pay the additional fee to get your credit score but we do not require you to do that.
 

Credit Report Instructions

  1. To get a copy of your credit report, go to www.annualcreditreport.com.
  2. Select the state that you reside in and click on “request report.”
  3. Provide your name, age, social security number, current address and previous address.
  4. Once you have supplied the necessary information, pick the consumer credit reporting agency of your preference. Equifax usually has the most information about people from the southeast. 
  5. Please note, you will only be able to access your free credit report from each agency once per year. We recommend pulling only one report at a time. 
  6. You may have the choice to purchase your score for $7.95. You can purchase it if you like, but the NGV counselor only needs the free report.
  7. Once you receive the report, please choose "Save as a PDF" and upload a copy using the field below. 

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