Jacksonville.gov - Entrepreneurship Program

Please complete all applicable questions. Information collected will be used to administer the program, evaluate program fit, and coordinate participant support and accommodations.

IMPORTANT PROGRAM NOTICE: This is an educational and business-development program. Participation does not include or guarantee funding, grants, loans, financial assistance, or other monetary awards. The program provides education, training, mentorship, resources, and connections to support business development or growth.

Please Complete the Program Application

Full Name

Date of Birth

Phone Number

Home Address

ZIP Code

Preferred Method of Contact

Do you have a documented disability?

Yes No Prefer not to answer

If yes, please describe how we can best support you during the program

Do you currently receive Social Security benefits?

Yes No Prefer not to answer

Do you require any accommodations to participate in this program?

Yes No

If yes, please specify

Do you currently own a business?

Yes No

If yes, please describe your business or business idea in a few sentences

What stage is your business in?

If other, please explain

What are your biggest challenges in starting or growing a business?

Why do you want to participate in this program?

What skills or knowledge do you hope to gain?

Are you willing to commit to attending workshops, mentorship sessions, and completing program requirements?

Yes No Need to discuss

How did you hear about this program?

Type Full Name to Acknowledge

By typing my full name above, I acknowledge that the information provided in this application is accurate to the best of my knowledge; submitting an application does not guarantee acceptance; and participation does not include or guarantee funding, grants, loans, financial assistance, or other monetary awards.

Security Confirmation

City of Jacksonville Disabled Services Division

117 W. Duval St., Suite 205, Jacksonville, FL 32202
Phone: (904) 255-5466 | TTY: (904) 255-5475
Email: DisabledServices@coj.net

Reasonable accommodations and accessible formats are available upon request. Program dates, deadlines, locations, and partner information may vary by program cycle.

Entrepreneurship Program for Individuals with Disabilities

Entrepreneurship Program for Individuals with Disabilities

Please Complete the Program Application