| Entrepreneurship Training Workshop Confidential Application Form |
| 1. | Workshop: |
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| 1. | Name: | |
| 2. | Sex: | Male Female |
| 3. | Home Address: | |
| Work Address: | |
| Email: | |
| Telephone: | |
| 4. | Age: | |
| 5. | Family Status: |
Never married Married Divorced Widowed |
| 6. | Do you have children?: |
Yes No |
| 7. | Level of Education (mark the correct response(s)): |
Primary . . . Did you graduate?
Yes No
Name of School:
High School/Secondary School . . . Did you graduate?
Yes No
High School/Secondary School . . . Did you graduate?
Yes No
Name of School:
Technical or Polytechnic School?
Yes No
How long?
Did you receive a graduation diploma or certificate?
Yes No
What were your areas of study?
Name of School?
University or Professional . . . How many years?
Do you have a degree?
Yes No
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| 8. | Have you ever been an apprentice? |
Yes No |
| 9. | Organization/Person: |
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| 10. | Did your father or mother ever own their own business?
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Yes No
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| If yes, did you work in the business? |
Yes No
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| 11. | Think of your three closest friends. Write their names and occupations below: |
Write their names and occupations below:
Name of Friend #1:
Is this friend in business for himself/herself?
Yes No
Name of Friend #2:
Is this friend in business for himself/herself?
Yes No
Name of Friend #3:
Is this friend in business for himself/herself?
Yes No
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| 12. | Did any of your friend's fathers or mothers own their own business? |
Yes No
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| 13. | How many people do you know well personally who own their own business? |
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| 14. | Were you the first child born in your family? |
Yes No
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| 15. | Have you traveled outside of your country? |
Yes No
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If yes, list the countries where you have traveled most frequently and how many times have you traveled to each |
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Country
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Number of Times
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How many times a year do you travel to places in your country outside of the region where you were born or where you currently live?
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Please list your past work experience below, with your most recent job first:
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| 17. | Have you ever tried to start your own business? |
Yes No
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What kind of business?
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What happened to this business?
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| 18. | Are you presently in business for yourself? |
Yes No
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What kind of business?
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| 19. |
If you intend to start a business or expand your current business, what kind of business will you start/expand? (Please give details) |
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| 20. |
If you do not intend to go into business right away, how do you intend to make use of this entrepreneurship training? |
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| 21. |
How much capital do you think you will need to start up or expand your business? |
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| 22. |
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Estimate the amount from each of the following sources that you can put into starting/expanding your business:
Your own money:
Loans or gift from family:
Loans or gifts from friends:
Other sources: Specify:
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| 23. | Do you own your own home, apartment or land? |
Yes No
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| 24. | Which one of the following ingredients needed to succeed in business do you think is the most important? (Mark one only.) |
Money Education Friends Motivation Other
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| 25. | Do you agree or disagree with the following statement? |
“It is more important for a job to offer opportunity than security.”
Agree Disagree
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| 26. | |
Use your imagination and try to think of as many uses as possible for sawdust or products that could be made of sawdust.
1. 4.
2. 5.
3. 6.
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| 27. | Do you agree or disagree with the following statement? |
“There are enough opportunities for people like me to start their own businesses in this country.”
Agree Disagree
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| 28. | Imagine that your brother or sister has sent you a gift of JD 30,000 to spend as you like. |
What would you do with it?
First use:
Second use:
Third use:
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| 29. | If you could have your boss’s job and salary for the next five years of your life, would you take it? |
Yes No
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| 30. | How would you describe your desire to start a new business or expand your existing business? (Mark one answer only) |
Don't know Average Somewhat strong Very strong
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| 31. | At this stage, what are the chances of success for your business? (Mark one answer only.) |
10% 20% 30% 40% 50%
60% 70% 80% 90% 100%
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Please explain why this is the case.
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| 32. | Are you willing to spend two uninterrupted weeks in the course?? |
Yes No
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| 33. | How did you hear about this program? |
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| 34. | What other entrepreneurship or business development workshops or courses have you attended? Please give dates. |
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| 35. | Describe your business or ideea/project of business: |
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