Suffolk County Community College

ENTREPRENEURIAL ASSISTANCE PROGRAM APPLICATION
Registration Form


Please complete all sections (6 sections) in this application. All sections may be printed.


You may also print and send the entire printed packet directly to:

SUFFOLK COUNTY COMMUNITY COLLEGE
Daphne M. Gordon
Project Administrator, Entrepreneurial Assistance Center
SALLY ANN SLACKE CENTER
Corporate Training and Economic Development
Crooked Hill Road, Brentwood NY 11717


Tel: (631) 851-6224 Fax: (631) 851-6222




STUDENT APPLICATION
Please fill in all fields.

First Name

Last Name

Address

City

 Zip

 Phone #

E-mail

 

 

Currently in Business?   No If No, please put NA in boxes below   Yes

If YES, Business Name

How long have you been in business?

 Business Type (Select one)

 

 

Describe business you are in or business you plan to start

 

 

Do you have experience in this field?   No   Yes

List education and experience in this field or education/experience needed

 

 

What are your expectations from the program?

 

 

This is a ten (10) week program. Will you make the commitment
to complete the program if you are selected?
   No   Yes

 

 

TUITION FOR THIS PROGRAM IS $275.00

The tuition is due and payable to "Suffolk County Community College - E.A.P." prior to joining the class.

Optional information for the Department of Economic Development reports

Ethnic Background:

Do not wish to participate   Black   Hispanic   Asian   Native-American   Non-Minority