Entrepreneurial Empowerment Program (EEP) - Intake Form
Welcome to the Entrepreneur Empowerment Program (EEP) Intake Form! This form is designed to gather essential information about you and your business to help us understand your entrepreneurial journey and specific needs. The EEP is dedicated to equipping local entrepreneurs with the tools, guidance, and support they need to achieve impactful growth, create employment opportunities, and foster sustainable economic development within our community. By providing details about your business vision, challenges, and goals, we can ensure you receive tailored support throughout the program.

Please fill out each section as thoroughly as possible. If you have any questions, feel free to contact us; ecdev@flagstaff.ab.ca.
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Email *
Program Eligibility
Note: This program is strictly limited to small businesses located within Flagstaff County's borders. Businesses located outside Flagstaff County are not eligible for this program, even if they serve customers within the region.

This initiative is part of Flagstaff County's ongoing commitment to support and promote local businesses in the Flagstaff Region.
Is your business/will your business be located within the Flagstaff Region? *
(Including all 10 towns, villages, and hamlets within Flagstaff County borders - Daysland, Strome, Killam, Heisler, Forestburg, Galahad, Alliance, Sedgewick, Lougheed, Hardisty).
Required
Date of Intake: *
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Personal Information
Full Name: *
Business Name (if available): *
Position/Title: *
Business Address: *
Business Phone Number: *
Business Email Address: *
Business Website (if applicable) *
If available, please provide a description of your business. (e.g., mission statement, business story, etc.) *
Business Overview
Business Type (please select all that apply) *
Required
Industry *
Required
Number of Employees (full time and part time): *
Years in Operation: *
Entrepreneurial Vision & Goals
What inspired you to start your business, and what is your long-term vision for it? *
What are your primary business goals over the next 1-3 years? (Check all the apply) *
Required
Please describe any specific challenges or obstacles you are currently facing. (e.g., lack of funding, limited market access, competition, staffing issues) *
Support Needs
What areas of support are your most interested in? (Check all the apply) *
Required
Are you seeking mentorship in specific areas? If so, please specify which areas would be most beneficial to you. *
Program Eligibility
Is your business located within the Flagstaff Region? *
Do you anticipate that your participation in the EEP will lead to job creation within the Flagstaff Region? *
Would you describe your business as having high growth potential or a focus on innovation? *
How will participation in the EEP help your business? *
Additional Information
How did you hear about the EEP (check all that apply) *
Required
Is there any other information you'd like us to know about your business, your entrepreneurial journey, or your expectations from the EEP? *
Declaration
By submitting the Intake Form, the Client agrees to the following clauses in relation to the Entrepreneur Empowerment Program (EEP):
  • I confirm that the information provided is accurate to the best of my knowledge and agree to be contacted by the Flagstaff County Economic Development team for further discussions regarding my participation in the  Entrepreneur Empowerment Program (EEP).
  • I acknowledge the resources, time, and effort being put into my business venture and agree to participate in the Entrepreneur Empowerment Program (EEP) with the full intention of enhancing my business and its contributions to the local economy.
  • I acknowledge that this is a highly collaborative process that requires my active participation and motivation to succeed. I will be an active contributor.
  • I acknowledge that if I become inactive in my communication and participation with Flagstaff County and its associated professionals for more than two weeks, my progress within the program may be suspended and should I want to continue, will have to reapply to the Entrepreneur Empowerment Program (EEP). If I am accepted again, I can restart from where progress was suspended.
  • I acknowledge that Flagstaff County is not providing me with professional advise, but rather offering itself as a source of support, information, guidance, and direction to further professional resources.
  • I understand that, except as described below, the information provided to Flagstaff County will be held in the strictest confidence.
  • I consent to he sharing of information I have provided with local departments and agencies for the purpose of evaluating and/or reporting to government funders.
  • I consent to the use of the information for policy analysis, research, and/or evaluation of Flagstaff County Economic Development programs.
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