Thank you for your interest in ACER services for business owners! Please fill out this form about you and your business. 1 Start 2 Complete Entrepreneur First Name * Last Name * Date of Birth (Enter in MM/DD/YYYY format) * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year19231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Year Home Street Address * Suite or Apartment Number City * State * Zip Code * Owner's Email * Phone Number * Gender * - Select -FemaleMaleNon-binaryChoose not to respondOther If you selected "other" gender, please specify: Pronouns How many people are in your household? * What is your household's yearly income? * - Select -Less than $20,000$20,000 - $44,999$45,000 - $84,999$85,000 - $139,999$140,000 - $199,999More than $200,000 What is your racial/ethnic heritage? (Check all that apply) * African (Liberian) African (Somali) African (Nigerian) African (Kenyan) African Native American/Alaskan Native African-American Asian (Hmong) Asian (Vietnamese) Asian Native Hawaiian/Pacific Islander Hispanic/Latinx Caucasian Prefer not to respond If you would like to specify your racial/ethnic heritage, please do so here: Are you a veteran? * Yes No Choose not to respond Are you a person with a disability? * Yes No Choose not to respond Name of Business * Business Street Address * Business Suite or Apartment Number City * State * Zip Code * Business Email * Is your business registered with the Minnesota Secretary of State? * Yes No What is your business Employer Identification Number (EIN) * How many years have you been in business? * Business type or legal entity for the brand * - Select -Sole ProprietorshipPartnership (LP/LLP)Corporation (C Corp/B Corp)Corporation (S Corp)Limited Liability Company (LLC)Corporation (non-profit) What is the primary industry for your business? * - Select -Agriculture, Forestry, Fishing and HuntingMiningUtilitiesConstructionManufacturingWhole Sale TradeRetail TradeTransportation and WarehousingInformationFinance and InsuranceReal Estate Rental and LeasingProfessional, Scientific, and Technical ServicesManagement of Companies and EnterprisesAdministrative and Support and Waste Management and Remediation ServicesEducational ServicesHealth Care and Social AssistanceArts, Entertainment, and RecreationAccommodation and Food ServicesOther Services (except Public Administration, e.g. Hair Salon, Nail Tech, Auto Repair)Public Administration Total number of employees (full & part-time) * Are you a home based business? * Yes No Do you conduct business online? * Yes No Education * - Select -Less than high schoolHigh school diploma/equivalent (GED)Associate degree/technical degreeBachelor's degreeGraduate/professional degree How did you hear about ACER? Check all that apply. * ACER Client ACER Employee ACER Website Other Website Bank Government Organization Social Media Other If you would like to specify which website, social media channel, or other way you heard about ACER, please do so here. Thank you! Have you participated in an ACER business training program? * Yes No Are you interested in participating in a business training program? If so which one? NDC Plan It! Mentorship Program CNA Training Preferred Communication Method(s) Phone Email Postal Mail SMS Fax Preferred Language - None -EnglishSpanishSomaliSwahiliHmong For men 18 yrs and older; are you registered for the selective service? Yes No Submit
