Alpine Business Class Registration

Personal Registration Info

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Name*

(Please include your preferred nickname in parentheses, if applicable)

First Last

Address*

Street Address City State ZIP Code

County (Example- Buncombe)*

Email*

Phone*

Please list any Western North Carolina community college, college or university you've graduated from

Demographics

Note: As a non-profit community development financial institution (CDFI), Mountain BizWorks prioritizes expanding opportunities for all, including communities that have been historically oppressed. The data collected herein such as race, gender, income enables to track our impact on diverse communities and is required by many of our funding partners.

Date of Birth

Gender*

Race/Ethnicity*

Primary Language*

Current Military Status*

Your Business

Business Name*

Please provide a one-sentence description or "elevator-pitch" for your business. (max 250 chars.)

Year Founded*

Business Mailing Address (if applicable)

Business mailing address is same as my home address

Business Mailing Address

Street Address City State ZIP Code

Business Physical Address

Physical address is same as mailing address

Business Physical Address

Street Address City State ZIP Code

Business Web Address

Annual Revenue

What big next step are you taking which will effect your bottom line?*

What goal would you like to examine in this course?

Course Registration Preference

Class will begin on the start date and will meet on the same weekday and time every week for five weeks. AM classes are held 9 am -12 pm. PM classes are held 6 pm - 9 pm.

Course Start Date*

Please select your preferred class start date. Don't see a class that fits your schedule? Please select your interest in either a morning or evening class and we'll contact you when additional course dates are released.

AM Alpine w/ Lisa Zahiya: February 21 – March 20 (Friday Mornings)
Shelby Alpine w/ Chris Grasinger: March 31 - April 28 (Tuesday Evenings)
Alpine for Makers w/ Lisa Zahiya: April 23 - May 21 (Thursday Mornings)
AM Alpine Waitlist (9am - 12pm class)
PM Alpine Waitlist (6pm - 9pm class)

Course Pricing and Scholarship Info

The course fee is $375. A minimum deposit of 50% of the total is due upon enrollment, with the remaining balance due one week prior to the first day of class. Acceptable forms of payment include cash, check, and credit card. There are a limited number of partial scholarships available for participants who qualify for assistance. These partial scholarships are awarded on a first come, first served basis. Please complete the scholarship section below to apply.

How would you like to pay for the course?*

Debit or Credit Card
Check
Cash

Scholarship application / code*

Would you like to complete the financial-need based scholarship application or have you been provided a scholarship code as an MBW loan client or via one of our partners?

Scholarship Code

If you've already been qualified for a scholarship as an MBW loan client or via one of our partners, please enter your code below.

Payment Details

Alpine Registration*

Total

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Scholarship Application

Mountain BizWorks and our funding partners strive to expand access to our services through offering financial-need based scholarships as current support allows. Please answer the following questions to the best of your ability and note these expectations of our scholarship awardees: 1) you'll need to provide documentation verifying your income level - see below; and 2) you'll agree to participate in an annual impact survey. Your information will be kept strictly confidential by Mountain BizWorks and, if required, by our scholarship funding partner. Please contact us if you need any assistance in completing the application.

Total Household Income*

Please enter the dollar amount of adjusted gross income as reported on your most recent tax return. If you share finances with a spouse and file jointly, please report the combined income total.

Projected Total Household Income for next tax reporting period*

Number of People in your Household*

Please enter the number of people in your household.

Additional Financial Situation Details

Please use this space to optionally provide any additional details on your current financial situation that may help clarify any of the answers above or otherwise help us consider your scholarship request.

Proof of Income & Identification*

Proof of income and identification is required to process your application. You may attach it below (fastest), email it to kareen@mountainbizworks.org, or bring it by the office. Acceptable proof of income includes A) most recent tax filing (first page only), B) most recent W-2, C) 2 consecutive paystubs, or D) other documentation deemed sufficient by MBW staff to verify the income reported above. Acceptably proof of ID includes a copy of your driver's license or other publicly issued ID.

Documentation is attached below
I'm emailing it to Kareen today
I need to bring it by the office

File Upload for Income & ID Documentation

Drop files here or

Max. file size: 1 MB, Max. files: 4.

Scholarship Certification*

Please enter your initials below to certify that the information provided herein is accurate and complete to the best of your knowledge.

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How did you hear about this class?*

Word of Mouth
Mountain BizWorks
Local Economic Development Organization
Web Search
Social Media
Outreach Event
Other

If you heard about this class through Word of Mouth,*

Please tell us a little bit more: your relationship to the source, an individual's name, or was it a past client? It is important to us to say Thank You to those in the community who led you to us!

Anything else?

Any other comment or question regarding this registration submission? We would like to know if you have any special class needs such as a disability that could affect your mobility or learning, or if you know you have to miss a certain class date, etc.

Refund Policy

Class registration requires payment in full on or before the first day of class. If you have paid for a class and must cancel your registration, you may choose to hold a credit or receive a refund according to the following: a) Cancel more than 1 week prior to class start date: 100% refund b) Cancel within 1 week of class start date: 75% refund c) Cancel on or after class start date: No refund. Credit in the full dollar amount for use with a future Foundations class, must be used within 6 months of original class date.

By submitting my registration, I understand that I will receive the Mountain BizWorks newsletter via email, and I can unsubscribe at any time.