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City of Jacksonville

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Entrepreneurship Program for Individuals with Disabilities

Application Form

Thank you for your interest in our Entrepreneurship Program for Individuals with Disabilities. Please complete the form below to apply.

Applicant Information

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Today
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Preferred Method of Contact:*


Disability Information

This information helps us tailor the program to your needs.

Do you have a documented disability:*

(e.g., accessibility needs, assistive technology, accommodations, etc.)
Do you currently receive Social Security benefits :*

Business Idea & Experience

Do you currently own a business:*

What stage is your business in:*


What type of business are you interested in:*



What are your biggest challenges in
starting or growing a business:*





Program Expectations

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Are you willing to commit to attending
workshops, mentorship sessions, and
completing program requirements:*

Additional Information

Do you require any accommodations to participate in this program:*

How did you hear about this program:*



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By submitting this application, I confirm that the information provided is accurate.
I understand that acceptance into the program is based on eligibility and program capacity


 

For Questions, please contact 904-255-5466.

We look forward to supporting your entrepreneurial journey!