Startup Now Logo

Application for Program Participation





Contact and Preliminary Information:

Cohort:  
Participant:  
First Name:   Middle Initial: Last Name:  

SSN:   Date of Birth:   (MM/DD/YYYY)

You must be registered in Employ Florida at www.EmployFlorida.com
Employ Florida Log in Username:  

Address: Email:

City: State: Zip:

Primary Phone Number:  

Secondary Phone Number:

How did you hear about Start-Up Now?  
If Other, specify:



This program provides intensive training in order to start a business using a hands-on approach. It requires your dedication and commitment. The following is key information about the program :
  • The program is open to anyone who is committed to starting their own business.
  • You must be able to support yourself during the entire duration of the program (6 - 7 months).
  • You can work during the program, but coursework out of classroom time will take 15 - 20 hrs./week.
  • Not everyone who applies will be selected to participate.
  • Not everyone who is accepted will progress through each step of this program.

This program provides intensive, hands-on training to start a business. The following is key information about the program:
  • The program is open to anyone who is committed to starting their own business.
  • You must be able to support yourself during the entire duration of the program (7 months).
  • Work outside of the sessions will take 15 - 20 hrs./week.
  • Not all who apply will be selected. Not all who are accepted will progress through each step of this program.
  • You are committing to spend your money meeting specific milestones to launch your business.
  • Businesses must be opened in South Florida.
  • You must apply as a continuing education student at Broward College. (We will facilitate this.)
  • You must apply as a credit-earning, non-degree seeking student at Broward College. (We will facilitate this.)
  • All requested documentation must be provided.
Considering the above requirements, are you able to commit to this 7 month program?  

How many people, including yourself, live in your household?  

What is your status in the family?  

How many children live in the home?  

Were you laid off from your last job?  
If so, when was your last date of employment?   (MM/DD/YYYY)

What was your last hourly wage? $  

Have you received unemployment compensation within the last 6 months?  

Have you received public assistance within the last 6 months?  

What is your total gross family income (before taxes & deductions)?
Please include income from all people living in the home    $.00  

Are you currently enrolled in CareerSource's WIOA program?  

Have you ever been enrolled in other CareerSource Broward programs?  
If so, list them:

Background Information:

Sex:  

Citizenship/Legal Status:  

What is your primary language?  

Are you currently in school, or participating in any kind of instruction or training?:  

If you answered yes, what is it and where are you receiving the instruction?  

What is your highest level of education?  

Year diploma, degree, or certificate was earned?  

Field of study:  

Other training, certifications, or licensures:

Have you served in the military?  

Have you registered for Selective Service?  

Do you consider yourself as having a disability?  

Are you an ex-offender?  

Are you homeless?  

Employment History:

What is your current employment status?  
If Other, specify:

If you are not working or are underemployed, what are you doing now?  
If Other, specify:

What is/was your most recent job title, or if you are not working now, what was your most recent job title?  

What type of business are you or were you last working in?  
If Other, specify:

Was your current/most recent job full-time or part-time?  

How many years of management experience do you have?  

Previous Self-Employment History:

Are you self-employed now?  

Have you been self-employed in the past?  

How long have you been, or were you self-employed?  

How many hours per week are you engaging in or did you engage in self-employment?  

Including yourself, how many employees work(ed) in the business?  

In what type of business are/were you self-employed?  
If Other, specify:

Your Business / Service IDEA:

Do you have a business idea (product or service) that you are interested in bringing to market?  

If so, at what stage are you?  
If Other, please explain:



In fifty words or less, answer these questions:
  1. What problem is your product or service solving?
  2. How will you make money?
  3. Is there an innovative aspect to your business idea?
 

Details:

Email the following documentation to Douglas Sáenz at dsaenz@careersourcebroward.com

Checklist —

☑ Your resume

☑ Color copy of your DD-214 (if a veteran)

☑ Color copy of your proof of Selective Service Registration. Must be registered with the Selective Service System (if born male on or after Jan 1, 1960). Go to www.sss.gov, then click “Registration” then “Check Registration”.)

☑ Color copy of your signed Social Security card.

☑ U. S. citizens – color copies of:
  • your driver’s license, AND
  • U.S. issued passport OR birth certificate.
☑ Non-citizens – color copy of:
  • your driver's license, AND
  • resident card OR work permit authorization.
☑ Florida Residency - Refer to Section #2 on this linked document to see what documents are required prior to starting the program. Key points:
  • Make sure all copies are color copies
  • All documents must be dated, issued or filed at least twelve (12) months before the first day of the program
  • Documents must not be expired
  • Either two items from tier one OR one item from tier one and one item from tier two are required
☑ OFFICIAL college or high school transcripts. These are sent directly from the high school, college or university. Have these sent to:
  • Electronically: whc-admissions@broward.edu
  • Mail: Broward College Admissions, 111 E. Las Olas Blvd., Bldg. 33, Room 219, Fort Lauderdale, FL 33301
Acknowledgement Form – Innovation Hub

Personal Information and Emergency Contacts Form

Signed Participation Agreement

Audio/Video/Print Release Form

Records Release/Consent Form

FERPA Release Form (Under "This release/disclosure may be made to..." you must type in CareerSource Broward / Start-Up Now. Under "Types of Education Information to Release", you must check “Academic Grades”, “Academic Records” and “Registration”)



Start-Up Now promotes entrepreneur skills and is presented by CareerSource Broward in partnership with the Innovation Hub @ Broward College. Begun under Federal award ED16HDQ0200018 from the Economic Development Administration, U.S. Department of Commerce, Start-Up Now is now privately funded through generous sponsors. The structure, process, selection and final outcomes are those of CareerSource Broward and the Innovation Hub @ Broward College and do not necessarily reflect the views of the Economic Development Administration, the U.S. Department of Commerce or private sponsors. An equal opportunity employer/program.

An equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities.

Startup Now Application Copyright © 2020 CareerSource Broward Employment Solutions