Application for Operation JumpStart Fall 2016 Session
_______________ _________________________ _________________________ ______________
Date First Name Last Name Date of Birth
____________________________ _______ _____________ ____________________
City of Residence State Zip Code County
_________________ _________________________ ___________________________
Home Phone Number Cell Phone Number Email Address
________________________ Can you receive calls at work? Yes No
Work Phone No
Class location is the Keeton Room in the Industrial Technology Complex on the Grenada campus of Holmes Community College.
Present employment status? Dislocated workers check the last box and give company information.
Full Time (more than 35 hrs/week) Seasonal Employment
Part Time Unemployed less than 6 months
Full Time Self Employed Unemployed more than 6 months
Part Time Self Employed Unemployed more than 2 years
What company_______________________ In what city is this company located?__________________
Have you ever operated a business? Yes No
Do you currently operate a business? Yes No
Which of the following apply to you? (Choose as many as you like)
Trying to decide if business ownership is right for me, or if my business idea is viable,
through the development of a plan.
Need assistance and/or capital to stabilize my existing business.
Need assistance and/or capital to expand my existing business.
What are your expectations for the amount of annual income (salary you pay yourself, profits, or other funds that are used for household expenses) from your business that you will be able to take next year? ___________________________________________________________
Send Completed Operation JumpStart application to:
Grenada County Economic Development District
2000 Gateway St., Suite 140
Grenada, MS 38901
Program Cost is $85 / includes textbook and class materials