Application for September - December 2015 Coaching
RequiredRequired Question(s)

Thank you for your interest  in our coaching programs. 75% of funding is by State of Maryland's Department of General Services (DGS), U.S. Small Business Administration and corporate sponsors.  

 

Please complete the application below.  The purpose of this application is to collect information for the selection committee to determine if this program meets your needs.

 

The program materials are specifically designed for each program based on revenue. Our certified business coaches will be working in each program with a small select number of non-competing business owners who are poised to "Increase Profits 61% in 12 months & Build Equity of $10 Million+ in 5 years." Only completed applications can be considered.


For questions, contact

J. Garrett Glover, Ph.D 

 jglover1@umd.edu 

240-708-0307


Select 1 of the 3 programs below that meets your revenue level and then the date / location that works best for you.

 

CEO Accelerator

6 Strategic Growth Planning Sessions & 6 Leadership Roundtables (36 Total Hours)
Designed for Owners with Revenue Above $500k
4 Day Retreat at Rocky Gap Resort (Cumberland) Mon.10/26 (2pm)-Thurs.10/29 (2pm) $650 + Resort (Opitional) $630
12 Tuesdays in Southern MD (Hughsville) 9/22-12/15 (9am-12pm) $475
12 Fridays at Merrill Lynch (Hunt Valley) 9/25-12/18 (9am-12pm) $475

Growth Accelerator

5 Strategic Growth Planning Sessions & 1 Leadership Roundtables (18 Total Hours)
Designed for Owners with Revenue Below $500k
2 Day Retreat at PSI Financial (Hunt Valley) Thurs 10/22 (8am)-Fri.10/23 (5pm) $340 + Hotel (Optional) $125
6 Wednesdays in Southern MD (LaPlata) 9/23-10/28 (9am-12pm) $250
6 Thursdays at Mt. St. Mary's Unv. (Frederick) 9/24-10/29 (9am-12pm) $250
6 Tuesdays in Southern MD (Hughsville) 11/3-12/15 (6pm-9pm) $250
6 Wednesdays at ACS Executive Suites (Largo) 11/4-12/16 (9am-12pm) $250*
6 Thursdays at MCE (Columbia) 11/5-12/17 (9am-12pm) $250*
*Limited number of full scholarships are available for State of Maryland Certified Minority Business Enterprise (MBE) planning to attend the Growth Accelerators in Largo and Columbia. Scholarships funded by CapitalOne Bank. See below to seek scholarship.
 

Strategic Launch

6 Strategic Planning Sessions (18 Total Hours)
Designed for Pre & Early Ventures
6 Tuesdays in Southern MD (Hughsville) 9/22-10/27 (6pm-9pm) $250
Unable to Attend. Contact me for Upcoming Sessions
Required
Please enter the information indicated below.

First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
City:
State/Province
(US/Canada):
Postal Code:

Cell Phone #

 

50 characters left.
Required
What Maryland County is your business located? If DC or out of state, list nearby Maryland County.

  

 

50 characters left.
Required
Are you committed to attending all scheduled sessions for the program you selected? Please look at your rush hour drive time to the location. If no, please indicate which session (s) you will be missing. We understand if emergencies arise, but each session is a carefully designed building block on the previous sessions.   
Yes
No
  • Comment:

  • 500 characters left.
Required

Funding by corporate sponsors, academic partners, State of Maryland's Department of General Services (DGS) and U.S. Small Business Administration makes it possible for the SBDC to offer its high-level, comprehensive coaching programs at a fraction of the cost. Do you agree to pay the listed material fee upon acceptance into the program? 


Full scholarships are available for State of Maryland Certified Minority Business Enterprise (MBE) planning to attend the Growth Accelerators in Largo and Columbia.   

 
Yes
Seeking MBE Full Scholarship for Growth Accelerators in Largo or Columbia
No
Required
This program is exclusively for the majority business owner. Are you the business owner? If not, please list your job title:
 

50 characters left.
Required

Gender

Male
Female
Choose not to respond
Required
Race
Alaska Native
Asian
Black or African American
Native American
Native Hawaiian or Pacific Islander
White/Caucasian
Choose not to respond
Required

Ethnicity

Hispanic or Latino
Non-Hispanic or Latino
Choose not to respond
Required

Veteran Status

Non-Veteran
Veteran
Service-Disabled Veteran
Choose not to respond
Required

Military Status

National Guard
National Guard - Active Duty
None
Reservist
Reservist - Active Duty
Choose not to respond
Required

Do you consider yourself a person with a disability?

No
Yes
Choose not to respond

Are there any other individuals involved in key decision making, e.g. spouse or partners? If so, list them.

 

350 characters left.
Required
Business Ownership - What percentage of your business is male or female owned?
 

50 characters left.
Required

Date Business Started:

 

50 characters left.
Required
What is the legal entity of your business?
Sole Proprietorship
Corporation
LLC
S-Corporation
Partnership
Other  
Required
Please answer the following:
 Yes No    
Are you currently exporting?    
Do you conduct business online?    
Are you a home based business?    
Are you 8(a) certified?    
Required
Type of Business (e.g. IT, electrical contractor, laboratory, lawyer, etc.):
 

50 characters left.

If possible, please provide your primary NAICS code.

 

50 characters left.
Required

Primary Market

Large Corporations
Small Businesses
Consumer
Goverment
International
Other  
Required
Briefly describe your company's product/service:
 

350 characters left.
Required

How are you different from your competition?

 

350 characters left.
Employee Count Information (enter zero if none)
 
Required
Full-time employees (35+ hours)
 

50 characters left.
Required

Part-time employees (<35 hours) 

 

50 characters left.
Required
1099 Contracted Personnel
 

50 characters left.
Financial Information:  (These will not be shared but you will need this data to complete your Strategic Growth Plan)
 
Required
Does your business have Accountant Prepared Financial Statements?
Yes
No
Required

What were your Gross Revenues/Sales ($) on your most recent tax return?

 

50 characters left.
Required

What were your +Profits/-Losses ($) on your most recent tax return?

 

50 characters left.
Required

What are your growth goals, both in 12 months and 5 years (e.g. revenue, market share, product/service line, # of employees, etc.)?  

 

1000 characters left.
Required
Your business coach will personally assist in the development and implementation (execution) of a Growth Plan to reach your goals. What are both the internal and external opportunities and obstacles facing your business? What resources (mind-set, skill-set and tool-set) do you believe you will need to build on your opportunities and address your obstacles?  
 

1000 characters left.
Required

Are you committed to working 2 hours per week on your Growth Plan between each session?

Yes
No
Required
After the program, are you committed to spending time each week to implement your Growth Plan and meet monthly with your SBDC coach for at least 6 months?
Yes
No
Required
How did you hear about this program (who were you referred by)?
Referred by SBDC Staff
Website
Email
Other  
Required
When did you last meet with a SBDC Counselor/Consultant? If possible, list the name of your current SBDC counselor in the comment field below. 
Recently, less than 3 months ago
9-12 months ago
More than 1 year ago
Never
Not sure
  • Comment:

  • 500 characters left.
Required
I request business management assistance from the Maryland Small Business and Technology Development Center. I agree to cooperate should I be selected to participate in surveys designed to evaluate the Maryland Small Business and Technology Development Center's services. I authorize the center to furnish relevant information to the assigned management counselor(s), although I expect that information to be held in strict confidence by him/her. I further understand that all counselors have agreed not to 1) recommend goods or services from sources in which they have an interest, and 2) accept fees or commissions developing from this counseling relationship.  By my signature below, and in consideration of the center's furnishing of management or technical assistance, I waive all claims against the center's personnel and its host organization. I understand that there are no warranties or assurances in connection with the counseling assistance. I self-certify that neither I nor my company have been suspended or debarred by a Federal Agency


 

50 characters left.