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2010 Streetwise MBA Application

All information will be kept strictly confidential and used for the sole purpose of applying to the program.

I am applying to the 2010 Streetwise MBA program in the following location: *

Boston

Worcester

Lowell

First Name: *

Last Name: *

Title:

Business Information

Business Name: *

Street: *

City: *

State: *

ZIP Code: *

Business Phone: *

Cell Phone:

Fax:

Business Email: *

Website URL:

Home Address

Street: *

City: *

State: *

ZIP Code: *

How did you hear about InnerCity Entrepreneurs?:

Please describe the nature of your business:

Construction

Financial

Manufacturing

Retail

Services

Distribution/Wholesale

Technology

Arts/Entertainment

Recreation/Tourism

Health/Medical

Other

Provide a brief description of your business:

When did you start your business?:

(MM/YYYY)

Please provide sales and employment numbers in the fields below.

2008 Estimated

Revenue: $

Full-Time Employees:

Part-Time Employees:

Contractors:

2007

Revenue: $

Full-Time Employees:

Part-Time Employees:

Contractors:

2006

Revenue: $

Full-Time Employees:

Part-Time Employees:

Contractors:

2005

Revenue: $

Full-Time Employees:

Part-Time Employees:

Contractors:

What have been the company's primary accomplishments over the past few years?:

What have been the primary business challenges you have faced over the past few years?:

Have you sought assistance in overcoming these challenges?:

Yes

No

If yes, please list the programs, resources, or networks you have used:

If no, why have you not sought assistance?:

In your opinion, what worked and what did not work?:

Please list business associations and/or community organizations in which you are actively involved:

Class sessions are typically held on weeknights between 6:00 - 9:00 PM. Does this work for you?:

Yes

No

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Read The New York Times article
'StreetWise MBA'; Is it right for you?
'StreetWise MBA'; Now accepting applications for June 2010 - Apply online
Interise is hiring!

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