Application Form

If would like to download and send in the application via mail, click here.

* - required fields

YOUR INFORMATION

* NAME First (given)

Middle

Last (family)

Nickname (if any)

* ADDRESS

* CITY

* STATE

* ZIP CODE

MAILING ADDRESS (if different)

* HOME PHONE

CELL PHONE

* E-MAIL ADDRESS

* BIRTH DATE

* GENDER

ETHNICITY

* MARITAL STATUS	YesNo DO YOU SPEAK ENGLISH?	PRIMARY LANGUAGE
Do you require any special accommodations? If yes, please explain. YesNo Do you currently own a business? YesNo (The V-WISE program is designed for BOTH individuals who may currently own/operate a venture, and also those who desire to launch a venture in the future – thus your response to this question will have no bearing on your acceptance.)

MILITARY INFORMATION

* Branch of Military service	* Date of separation from active duty
* Military Specialty	* Rank at separation
* Disability StatusYes (determined under Section 3016 of Title 38, U.S.C. to have a serious employment handicap) No	Honorable Discharge YesNo

EDUCATION

Official Name of School	Location of School City,State	Dates of Attendance	Diplomas, Degrees, Certificates, Dates Received

SUPPLEMENTAL QUESTIONS Please respond, in 500 words or less, to each of the following questions

1) What is your primary reasoning for applying to the V-WISE program?

2) Describe your interest in entrepreneurship and business ownership, and suggest why you are a strong candidate for this program.

3) How did you hear about the V-WISE Program?

Enclosures (Attach the following):

Copy of DD 214, DD 220, or LES (please black out Social Security # before attaching)