Entrepreneur Application Thank you for applying to our Hustle PHX 101 program. This application will allow us to get a quick snapshot of who you are and allow us to learn more about your business so we may better customize future Hustle programs. By completing this application, you consent to the transfer of the information you submit. The information collected is for internal research purposes only and will not be publicly associated with you. However, we may share information of this application with the public anonymously or in aggregated forms.Required fields are indicated by an asterisk *Personal InformationFirst Name* E-mail Address* Last Name* Phone Number* Address* City* Zip* Primary Language*EnglishSpanishBilingual - English & SpanishOtherGender*FemaleMaleOtherBirthdate (__/__/____)* Age*Under 1616-1718-2425-3435-4445-5455-6465+Race/Ethnicity*American Indian or Alaskan NativeAsianBlack or African AmericanHispanic or LatinxNative Hawaiian or Pacific IslanderWhiteMultiple ethnicities/racesOtherMarital Status*Single, never marriedMarriedWidowedDivorcedSeparatedHighest Level of Education*Some middle schoolCompleted middle schoolSome high schoolHigh school degree or equivalent (e.g. GED)Some college, no degreeAssociate's degreeBachelor's degreeGraduate degreeCurrently in schoolEmployment Status*Employed, working 1-39 hours per weekEmployed, working 40 or more hours per weekNot employed, looking for workNot employed, NOT looking for workRetiredDisabled, not able to workStudentStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCountry*CanadaMexicoUnited StatesOtherTotal Household Income*$0 - $9,999$10,000 - $19,999$20,000 - $29,999$30,000 - $39,999$40,000 - $49,999$50,000 - $59,999$60,000 - $69,999$70,000 - $79,999$80,000- $89,999$90,000 - $99,999$100,00 or moreNumber of Members in Household1234567891010+Home Church (if applicable)Central Christian ChurchChrist Church of the Valley (CCV)New CityRedemption Church AlhambraRedemption Church ArcadiaRedemption Church TempeRedemption Church PeoriaRoosevelt Community ChurchScottsdale Bible ChurchOtherChurch Name (if not listed above) Name of Community Where You Live Name of Community Where You Work Affiliated Organization (if applicable)Alongside MinistriesEmpoweredHope Women's CenterNeighborhood MinistriesRehobothScottsdale Bible ChurchUnlimited PotentialBusiness InformationDo you have a business?*YesNoIf yes, tell us about your business below:Business Name Please describe your business in 1-2 paragraphs.Why did you start this business?What has been the most difficult part about your business and/or getting it started?Business Address Business City Business StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingBusiness Zip Business Phone Business Email If not, tell us about your business idea below:What is your business idea?Fall 2021If you're currently enrolled in a Spring 2021 cohort please select which onePalominoOther (more coming soon)Fall 2021 cohorts Palomino: Experience the full Hustle PHX 101 program in partnership with the Palomino community. This cohort will be held at the Scottsdale Bible Church: Cactus Campus on Monday evenings from 6pm - 8:30pm. This cohort is bilingual with a focus on Spanish speakers. This cohort begins August 23rd. A second cohort will be announced soon.Hustle PHXWhat interests you about Hustle PHX?*How did you hear about Hustle PHX?*ChurchEmail From Hustle PHXFriendGoogleHustle PHX WebsiteSocial MediaOtherAccount InfoBy creating an account below you are giving Hustle PHX permission to contact you in regards to our entrepreneur programs and events.Username* Password* Confirm Password* Only fill in if you are not human
