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					                                            Kawerak, Inc.
                                      Community Planning Department (CPD)
                                      P.O. Box 948 • Nome, AK • 99762
              Telephone: (907) 443-4250 • Toll Free 1-877-219-2599
                                 Fax: (907) 443-4449 • www.kawerak.org


         Kawerak Small Business Technical Assistance Program Client Questionnaire


Kawerak assistance
                   Areas you would like to receive assistance (rank in order of importance)
 Restore personal credit or create credit
   -Pay off debt and repairing your credit report (collections)
   -No credit history…learn how to get credit
 Business plan writing
   -Outline
   -Idea development and writing
 Financing
    -Identify funding sources
    -Loan qualifications
 Marketing
    -Develop advertisements or promotions
    -Identify magazines, web, trade shows, etc. to develop business
 Financial projections
    -Identify business expenses and income
    -Pricing products or services
    -Cash flow projections
 Financial record keeping
    -Basic bookkeeping
    -Quickbooks
 Business idea
   -Identify possible businesses to start


Client
                                               Personal Information

 Today’s date:             -     -
                     Mo.   Day   Year

 Full Name:
              Last                                                         First                       M.I.
 Address:
              Address


              City                                                                     State           ZIP Code
 Home Phone:         (     )      -                     Alternate Phone:       (   )           -

 E-mail Address:



    32cfbbf7-2f84-4a4b-a2b5-4330b4ea4626.doc                          Created by Lahka Peacock     8/22/2011 Page 1 of
    2
                                         Kawerak, Inc.
                                   Community Planning Department (CPD)
                                   P.O. Box 948 • Nome, AK • 99762
            Telephone: (907) 443-4250 • Toll Free 1-877-219-2599
                                Fax: (907) 443-4449 • www.kawerak.org


Business
                                                   Business idea
1. Do you wish to start a new business or expand an
existing business? If expanding, proceed to question 10               New business                   Expand business
2. Explain your business idea:
(Attach extra pgs. If necessary)




3. Do you plan to build, rent
or use a building you own?

4. How much money do you feel you will need to start
business? (If not known, state you do not know)

5. How much of your own money will you be
contributing towards the start of your business?

6. Who will buy your products or
use your services?



7. What is your primary motivation for
wanting to own your own business?




8. Are you currently working?                 If yes, will you continue working while starting your business?




   32cfbbf7-2f84-4a4b-a2b5-4330b4ea4626.doc                              Created by Lahka Peacock   8/22/2011 Page 2 of
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