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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.

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:

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 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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