Accessibility
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Please note: The information gathered on this form is kept strictly confidential. Your information is only used by SBDC staff and NOT made public, shared or available to third parties.
“SBDC services are provided in a nondiscriminatory way to all legal residents and citizens in the US”

Contact information: (Items with * are required) 

Are you Federally debarred or suspended?

Email address is required; phone number is strongly recommended

Best Contact Method

Request for counseling information*

Business Information:

Currently in Business?

Would you like to tell us more about yourself and/or your business? 

Fill out the optional fields below to better prepare your advisor for your meeting. 

Are you disabled?
Within the last 2 years have you ever received AFDC:
TANF:

Select the county you wish to receive counseling in (required):

PLEASE NOTE: If you are in New York City, the following counties correspond to the five Boroughs:

New York State Small Business Development Center Client Disclaimer (Required)

I request management assistance from The New York State Small Business Development Center. I understand that this assistance is free of charge and that I incur no obligation to The New York SBDC or the U.S. Small Business Administration or its counselors for providing this assistance. I agree to cooperate should I be selected to participate in surveys designed to evaluate assistance services. I authorize the New York SBDC to furnish relevant information to the assigned management counselor(s) although I expect that information to be held in strict confidence to the extent allowable by law.

 

I certify that I am legally authorized to receive taxpayer-funded assistance under federal law and regulations. I understand that the Staten Island Small Business Development Center is prohibited from providing services funded by taxpayer dollars to individuals not lawfully present in the United States. I affirm that the information provided is accurate.

I further understand that any counselor has agreed not to: (1) recommend goods or services from sources in which he/she has an interest and (2) accept fees or commissions developing from this counseling relationship. In consideration of the SBDC, in cooperation with the SBA furnishing management or technical assistance, I waive all claims against The New York State SBDC, SBA, personnel or counselors arising from this assistance.

Thanks for submitting!

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