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Initial Intake
Initial Intake Staff
Aru Sasikumar
Jamesetta Diggs
Fuad Salan
Christine Lukudu
Shoua Salas
Sohini Bag
Fadumo Mohamed
Denise Butler
Nelima Sitati Munene
Other
ACER Partners
Entrepreneur
Is your business registered with the Minnesota Secretary of State?
Yes
No
What is your business Employer Identification Number (EIN)
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!
Entrepreneurship Trainings
CNA Training
For men 18 yrs and older; are you registered for the selective service?
Yes
No
First Name
Last Name
Date of Birth (Enter in MM/DD/YYYY format)
Home Street Address
Suite or Apartment Number
City
State
- Select -
Zip Code
Owner's Email
Phone Number
Gender
Female
Male
Non-binary
Choose not to respond
Other
If you selected "other" gender, please specify:
Pronouns
How many people are in your household?
What is your household's yearly income?
Less than $20,000
$20,000 - $44,999
$45,000 - $84,999
$85,000 - $139,999
$140,000 - $199,999
More 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
Sexual Orientation
Outcome Reporting
Are you an ex-offender?
- Select -
Yes
No
Prefer not to disclose
Constituent Info - Individuals
What is your business revenue?
- Select -
0 - 50K
50k - 100k
100k - 250k
Over 250k
What services are you looking for from ACER?
Website Design/Development
Business Planning
Accounting
Financial Planning
Brand Development
Marketing/PR
Human resources
Legal & Insurance
Access to funding
Name of Business
Business Street Address
Business Suite or Apartment Number
City
State
- Select -
Zip Code
Business Email
How many years have you been in business?
Business type or legal entity for the brand
Sole Proprietorship
Partnership (LP/LLP)
Corporation (C Corp/B Corp)
Corporation (S Corp)
Limited Liability Company (LLC)
Corporation (non-profit)
Not Applicable / Not Registered
What is the primary industry for your business?
Agriculture, Forestry, Fishing and Hunting
Mining
Utilities
Construction
Manufacturing
Whole Sale Trade
Retail Trade
Transportation and Warehousing
Information
Finance and Insurance
Real Estate Rental and Leasing
Professional, Scientific, and Technical Services
Management of Companies and Enterprises
Administrative and Support and Waste Management and Remediation Services
Educational Services
Health Care and Social Assistance
Arts, Entertainment, and Recreation
Accommodation and Food Services
Other 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
1st Grade-11th Grade
High school diploma/equivalent (GED)
Associate degree/technical degree
Bachelor's degree
Graduate/professional degree
12th Grade, No diploma
Some College, not completed
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!
Preferred Communication Method(s)
Phone
Email
Postal Mail
SMS
Fax
Preferred Language
English
Spanish
Somali
Swahili
Hmong
THE BELOW QUESTIONS ARE FOR ACER STAFF TO ANSWER INTERNALLY
Yes
No
How prepared are the client for getting services with us?
What consultant do you recommend to this client?
How many hours is the client looking to dedicate to the program?
What tier level is this client on?
Tier 1
Tier 2
Tier 3
Why did you pick this tier ranking for the client?
Submit