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" indicates required fields
Name/Nombre
*
First
Last
Telephone/Teléfono
*
Email Address
*
Gender/Genero
*
Select Option
Female/Femenino
Male/Masculino
Age Range/Rango de Edad
*
Select Option
Younger than 18/Menos de 18
19 to 40
41 to 55
More than 56/Mas de 56
Country of Birth/Pais de Nacimiento
*
Select a Country
Argentina
Bolivia
Brasil
Chile
Colombia
Costa Rica
Cuba
Dominican Republic
Ecuador
El Salvador
Guatemala
Honduras
Mexico
Nicaragua
Panama
Paraguay
Peru
Puerto Rico
Spain
U.S.
Uruguay
Venezuela
If born in the U.S. country of Hispanic Heritage/Si nació en EE.UU. pais de procedencia Hispana
*
Select a Country
Argentina
Bolivia
Brasil
Chile
Colombia
Costa Rica
Cuba
Dominican Republic
Ecuador
El Salvador
Guatemala
Honduras
Mexico
Nicaragua
Panama
Paraguay
Peru
Puerto Rico
Spain
U.S.
Uruguay
Venezuela
Ethnicity/Etnicidad
*
Select Ethnicity
African American/Afroamericano
Asian/Pacific American / Asiático/Pacifico Americano
Caucasian/Caucasico
Central American/Centroamericano
Hispanic/Latino Americano
Native American/Nativo Americano
South America/Sudamericano
Are you a Veteran/Veterano de las Fuerzas Armadas de EE.UU?
*
Select Option
Yes/Si
No/No
Home Address/Residencia
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
County/Condado
*
Select a County
Atlantic
Bergen
Burlington
Camden
Cape May
Cumberland
Essex
Gloucester
Hudson
Hunterdon
Mercer
Middlesex
Monmouth
Morris
New York
Ocean
Other
Passaic
Salem
Somerset
Sussex
Union
Warren
District/Distríto
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Select a District
District 1 (Atlantic, Cape May and Cumberland)
District 12 (Burlington, Middlesex, Monmouth and Ocean)
District 23 (Hunterdon, Somerset and Warren)
District 24 (Morris, Sussex and Warren)
District 26 (Essex, Morris and Passaic)
District 36 (Bergen and Passaic)
District 37 (Bergen)
District 38 (Bergen and Passaic)
District 39 (Bergen and Passaic)
District 40 (Bergen, Essex, Morris and Passaic)
Other
If other county, please specify
If other district, please specify
Preferred language for class/Idioma preferido para clases
*
Select Option
English/Ingles
Spanish/Español
Business Name/Nombre del Negocio
*
Describe your product or service/Describa su producto o servicio
*
Business Industry/Industria del Negocio
*
Select an Industry
Accounting and Taxes/Contabilidad e impuestos
Business Consulting/Consulta y asesoria de negocios
Cleaning/Limpieza
Construction/Construcción
Consumer Goods/Bienes y Mercancias
Education/Educación
Event planning/Planeacion de eventos
Financial Services/Servicios financieros
Health and Wellness/Salud y Bienestar
Marketing/Mercadeo
Other
Restaurant and Food/Restaurante y comidas
Technology/Tecnología
Translation Services/Servicios de Traducción
Travel and Leisure/Viajes y Ocio
Websites and Social Media/Sitios web y redes sociales
If other industry, please specify
NAICS Code/Código de NAICS
*
If you are not sure about your NAICS codes, use this link to find them by industry:
https://www.naics.com/search-naics-codes-by-industry/
Telephone/Teléfono
*
Email/Correo Electrónico
*
Website/Sitio Web
*
Business Address/Dirección del Negocio
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
County/Condado
*
Select a County
Atlantic
Bergen
Burlington
Camden
Cape May
Cumberland
Essex
Gloucester
Hudson
Hunterdon
Mercer
Middlesex
Monmouth
Morris
New York
Ocean
Other
Passaic
Salem
Somerset
Sussex
Union
Warren
If other, please specify
Status of your concept/Estado de su concepto?
*
Select Option
Idea Under Research/Idea Bajo Investigación
Product or Service Launched/Product ya Lanzado
Do you have Intelectual Property/Tiene Propiedad Intelectual?
*
Select Option
Yes/Si
No/No
Years your company has been in business/Cuantos años tiene su empresa en el negocio?
*
Select Option
Less than 1 year/Menos de 1 Año
1 to 3
3 to 5
5 to 10
More than 10/Mas de 10
Business home-based/Negocio en casa?
*
Select Option
Yes/Si
No/No
Business rents space/Negocio en espacio alquilado?
*
Select Option
Yes/Si
No/No
Is business registered/Esta el negocio registrado?
*
Select Option
Yes/Si
No/No
What is the legal structure/Cual es la estructura legal?
*
Select Option
Sole proprietor/Proprietario único
LP
LLC
S Corporation
Corporation
What is the size of your team/Cual es el tamaño de su equipo?
*
Select Option
1-10 Employees/Empleados
11-20 Employees/Empleados
21-50 Employees/Empleados
50+ Employees/Empleados
Projected annual sales for 2025/Proyección de ventas para 2025?
*
Select Option
Less than $10,000/Menos de $10,000
$10,001- $20,000
$20,001- $30,000
$30,001- $50,000
$50,001- $100,000
More than $100,000/Mas de $100,000
Related to certifications, have you applied or received any of the following/En relación a certificaciones, ha solicitado o recibido alguna de las siguientes?
*
Select Option
Applied for NJ MBE-WBE or similar/Solicite para NJ MBE-WBE o certificaciones similares
Applied for WBENC-NMSDC or similar/Solicite WBENC-NMSDC o certificaciones similares
Obtained NJ MBE-WBE or similar/Obtuve NJ MBE-WBE o certificaciones similares
Obtained WBENC-NMSDC or similar/Obtuve certificaciones WBENC-NMSDC o similares
Applied for other certifications/Solicite otras certificaciones
Obtained other certifications/Obtuve otras certificaciones
If other certifications, tell us which ones/Si hay otras certificaciones, díganos cuáles
Have you prepared a business plan/Ha preparado un plan de negocio?
*
Select Option
Yes/Si
No/No
Do you have an accounting system in place/Cuenta con un sistema de contabilidad?
*
Select Option
Yes/Si
No/No
Have you applied for loans/grants, tell us which ones / Si hay aplico por préstamos/subsidios, díganos cuáles
*
The program consists of Friday sessions (during the morning) from January to May. Please confirm your schedule allows you to attend this program? / El programa consta de sesiones los viernes (durante la mañana) de Enero a Mayo. ¿Confirma que su horario le permite asistir a este programa?
*
Select Option
Yes/Si
No/No
Have you participated in our HETP or LETS program before/Has participado en nuestro programa del HETP o LETS anteriormente?
*
Select Option
Yes/Si
No/No
If yes, what program and year/En caso afirmativo, que programa y año?
*
Are you an SHCCNJ Member/Es usted SHCCNJ Miembro?
*
Select Option
Yes/Si
No/No
How did you hear about the LETS program/Cómo se enteró del programa?
*
Select Option
Carlos Medina
Luis de la Hoz
Jairo Borja
Other
If other, please specify/Si se entero por otro medio, especifique
*
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program_name
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