The CEI Women's Business Center Client Attribution Form

The CEI Women’s Business Center Client Attribution Form

Thank you for filling out this attribution form. By completing this form, you certify you worked with a business advisor, and they were meaningfully helpful. This includes business advisors at the Women’s Business Center and Small Business Development Center (SBDC)

We keep all information confidential, and report it only in aggregate. Your response keeps our funders happy, our advising services free and our workshops low cost. Depending on your work with us, you may only fill in some of the sections, and not others. Please be sure to initial the sections where you have responded.

"*" indicates required fields

Business Name*

Owner Name*

Business Start

Business Start Date

Enter the start date of your business. Note: “in-business” is defined by the Small Business Administration as having spent money on the formation, startup or operation of your business.

Business Entity Type

Ex. sole proprietor, partnership, LLC, S-Corp, C-Corp

% Female Ownership

What % of the business is female owned?

Certification (Please Initial)

My work with the CEI Women’s Business Center or the SBDC business advisor has been meaningfully helpful in starting my business. As a result of this work, I am now in business (defined by the Small Business Administration as having spent money on the formation, startup or operation of your business).

Job Creation

# Full Time Jobs Created

For new businesses, list the number of Full-Time jobs created. For existing businesses, list the number of jobs created because of the help you received from a business advisor. Note: You (as owner of this business) count as a job created if this is a new business, even if you are not legally an employee of your business.

# Part Time Jobs Created

For new businesses, list the number of Part-Time jobs created. For existing businesses, list the number of jobs created because of the help you received from a business advisor. Note: You (as owner of this business count as a job created if this is a new business, even if you are not legally an employee of your business.

# Jobs Retained

Skip this question if you are starting a new business. Jobs retained are jobs that would have been lost without the assistance of a business advisor. Note: This most commonly applies if you would have gone out of business but-for the advising you received, or if you are buying a business that otherwise would have closed.

Certification (Please Initial)

My work with the CEI Women’s’ Business Center or the SBDC business advisor has been meaningfully helpful in my hiring employees or creating a job for myself within my business.

Capital Contributed

Owner Contribution (Cash)

If you are starting your business with this loan, list the total amount cash you’ve invested thus far.

Grant Funds

List the total amount of grants received thus far.

Loan Funds

These include loans from formal lenders (banks, etc.) and more informal loans from friends, family, etc.

Other Funds Received

Other Funds (Source)

Certification (Please Initial)

My work with the CEI Women’s Business Center or SBDC business advisor has been meaningfully helpful in the investment of money in my business, in the amounts specified above.

Confirmation and Submission

Certification of Accuracy*

By checking this box, I certify that the information contained in this form is current and accurate to the best of my ability.

Date of Completion*

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Comments

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