The Institute for Economic Empowerment of Women.

PERSONAL INFORMATION

Your Name (required)

Preferred Name

Under U.S. BCIS rules, non-U.S. citizens must have a permanent address in their country of citizenship. Please provide your complete permanent mailing address.

Street Address (required)

City (required)

State/Region/Province (if applicable)

Country (required)

Home Phone (required)

Cell Phone

Email (required)

Married?
---YesNo

If married, Husband's name.

Do you have children?
---YesNo

If yes, tell us their name and age.

Date of Birth

Place of Birth

Country of Citizenship (required)

Passport # and expiration date (required)

A copy of your valid passport should be scanned and emailed to accompany this application. The passport must have an expiration date of no earlier than March 1, 2010.

Do you currently hold a U.S. Visa?
---YesNo

If yes, which kind
---F1J1B1Other

EDUCATION

Please list all schools that you have attended, list the diplomas or degrees obtained at each institution, and the years that you attended the institutions

EMPLOYMENT

EMPLOYMENT HISTORY Please provide us with a complete list of the kinds of work that you have done prior to opening your business. If you are still employed outside of your business, please provide that information as well.

SKILLS

SPECIAL TRAINING List any special training you have received

LANGUAGES Please indicate languages that you speak

COMPUTER SKILLS Please indicate your computer skill levels

ACTIVITIES AND INTERESTS List social, professional, and honorary organizations, including leadership positions and special awards or honors received.

YOUR BUSINESS

Business Name and address/location (required)

Please give us a complete description of your business including the kinds of products and services that provide. Bear in mind that we are not looking for one-word answers; rather a more complete understanding of your business and your relationship to that business.

How did you get started in your business? What was your inspiration?

Date opened Business

# of Employees

Do you have a partner(s)

---YesNo

If yes, how many partners?

If you have partners, please describe the relationship of the partnership.

Annual revenue

Currency Denomination

Expectation in attending this training.