Celebrating 25 Years! Business Name



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Celebrating 25 Years!




Business Name:




Business Owner(s):




Business Description:







Office Address:




Telephone:




Email:


Corporation

 Sole Proprietorship

Partnership

 Other (specify)



Year Business Established:







ACOA client:

 Yes  No

Number of Employees:




MBO client:

 Yes  No



Brief Description of the Project:

Type of Project:

 Diagnostic Assessment

Competitiveness Assessment

 Business Management Skills Development

Access to Capital

 Trade Assessment/Export Assessment





Consultant Information:

Company Name:




Consultant Name:




Mailing Address:




Telephone:




Email:


Project Costs:

Please provide a detailed statement of work from the Consultant outlining specific deliverables, cost per hour, total number of hours and a timeline for completion of the project. The Consultant may be reimbursed 75% of the costs of professional fees to a maximum of $5,000. The Applicant is responsible for the balance of the project costs.


Additional Information Requirements:

Profile of your organization, including a description of the product or service you offer.

 3 years of most recent financial statements.

 Description of your current situation and rationale for the proposed activity.

 Proposal from the Consultant (includes statement of work and company profile).
Funding for CAS has been provided by the Atlantic Canada Opportunities Agency (ACOA), and the Newfoundland and Labrador Association of Community Business Development Corporations (NLACBDC). I authorize MBO to share my contact information with these organizations for program evaluation purposes.

(Applicant’s Signature) Date





Name of Applicant (Print)
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