Taking the Leap to Entrepreneurship Mentoring Program is partially funded by the Ministry of Jobs, Tourism and Innovation. The cost of the Mentoring Program is $150 per person.
In order to be eligible, you must be a woman in the early stages of operating a business, located in the province of British Columbia, over the age of nineteen and legally able to work in Canada. If you meet the eligibility criteria, we will contact you to set-up a phone interview. If your phone interview is successful and you are accepted into the Mentoring Program, your payment will be due within five business days of receiving the acceptance letter. Your place in the program will only be secure once the payment of $150 has been made.
*First Name:
*Last Name:
*Business Name:
*Mailing Address:
*City: - Select - 100 Mile House108 Mile Ranch150 Mile House70 Mile HouseAbbotsfordAgassizAinsworth HotspringsAiyanshAldergroveAlert BayAlexis CreekAlkali LakeAltonaAnahim LakeAnglemontAnmoreAnnacis IslandArgentaArmstrongArrasAshcroftAspen GroveAthalmereAtlinAvolaBaldonnelBalfourBamfieldBarkervilleBarriereBear LakeBeaverdaleBeaverdellBelcarraBella BellaBella CoolaBig LakeBlack CreekBlind BayBlind ChannelBlubber BayBlue RiverBoston BarBoswellBowen IslandBowserBrackendaleBrentwood BayBridevilleBridge LakeBriscoBrittania BeachBrookmereBuffalo CreekBuickBurnabyBurns LakeBurtonCache CreekCampbell IslandCampbell RiverCanal FlatsCanim LakeCanoeCanyonCassidyCastlegarCawstonCecil LakeCedarCedarvaleCelistaCentral SaanichCharlie LakeChaseChemainusChetwyndChilanko ForksChilliwackChristina LakeClayhurstClearbrookClearwaterClintonCloverdaleCoal HarbourCoalmontCobble HillColdstreamColwoodComoxCoombsCoquitlamCortes IslandCourtenayCowichan BayCranbrookCrawford BayCrescent SpurCrescent ValleyCrestonCroftonCultus LakeCumberlandCurzonD'ArcyDarfieldDawson CreekDawson LandingDease LakeDeltaDenman IslandDeRocheDesrocheDewdneyDog CreekDome CreekDouglas LakeDuncanDunsterEagle BayEagle CreekEarls CoveEdgewaterEdgewoodEgmontElkfordElkoEndakoEnderbyEricksonErringtonEsquimaltFairmount HotspringsFalklandFanny BayFarmingtonFauquierFernieFieldForest GroveFort FraserFort LangleyFort NelsonFort St. JamesFort St. JohnFort SteeleFrancois LakeFraser LakeFruitvaleFulfordGabriolaGaliano IslandGallowayGang RanchGarden BayGaribaldi HighlandsGenelleGermansen LandingGibsonsGilles BayGitanmaaxGitanyowGitseguklaGitwangakGitwinksihlwkGlen VowellGold RiverGoldbridgeGoldenGoodlowGrand ForksGranisleGranthams LandingGrasmereGray CreekGreenvilleGreenwoodGrindrodGroundbirchGulf IslandsHagensborgHagwilgetHalfmoon BayHancevilleHaneyHarrison Hot SpringsHarrison MillsHarrogateHartley BayHazeltonHedleyHefley CreekHeriot BayHixonHolbergHoneymoon BayHopeHornby IslandHorseflyHoustonHudson's HopeHuntingdonIax Kw'alaamsInvermereIskutJaffrayJoe Rich-EllisonJordan RiverJuskatlaKaledenKamloopsKasloKeats IslandKelownaKemanoKeremeosKimberleyKincolithKingcome InletKingsgateKispioxKitchenerKitimatKitimat VillageKitkatlaKitselasKitsumkalumKitwangaKleena KleeneKlemtuKnutsfordKoksilahKootenay BayKuper IslandKyuquotLac La HacheLac Le JeuneLadnerLadysmithLake CountryLake CowichanLake ErrockLakeview HeightsLangleyLantzvilleLasquetiLavingtonLazoLikelyLillooetLindell BeachLions BayListerLittle FortLogan LakeLone ButteLongworthLouis CreekLower NicolaLumbyLundLyttonMacKenzieMadeira ParkMahood FallsMalahatMalakwaMalkawaManning ParkManson CreekMansons LandingMaple BayMaple RidgeMaraMarysvilleMason's LandingMassetMatsquiMayne IslandMcBrideMcClureMcLeese LakeMcLeod LakeMeadow CreekMerrittMervilleMesachieMetchosinMeziadin LakeMica CreekMidwayMill BayMilnerMinstrel IslandMissionMoberly LakeMonte CreekMonte LakeMontneyMontroseMoricetownMount CurrieMount LehmanMoyieMuncho LakeNakuspNamuNanaimoNanoose BayNaramataNazkoNelsonNemiah ValleyNew AiyanshNew DenverNew HazeltonNew WestminsterNewtonNimpo LakeNorth BurnabyNorth CowichanNorth DeltaNorth HazeltonNorth PineNorth SaanichNorth ShuswapNorth SurreyNorth ThompsonNorth VancouverOak BayOcean FallsOkanagan CentreOkanagan FallsOliverOoona RiverOsoyoosOyamaOyamaPanoramaParksvilleParsonPavilionPeachlandPembertonPender IslandPennyPentictonPinanton LakePink MountainPitt MeadowsPort AlberniPort AlicePort ClementsPort CoquitlamPort EdwardPort HardyPort McNeillPort MellonPort MoodyPort NevillePort RenfrewPort SimpsonPouce CoupePowell RiverPrespatouPrince GeorgePrince RupertPrincetonPritchardProcterProgressProphet RiverQuadra IslandQualicum BeachQuathiaski CoveQuatsinoQueen Charlotte CityQueen Charlotte IslandsQuesnelQuilchenaRadium Hot SpringsRefuge CoveRevelstokeRichmondRiondelRiske CreekRivers InletRoberts CreekRobsonRock CreekRollaRose PrairieRosedaleRosslandRoystonRutlandSaanichSaanichtonSaanichtownSalmoSalmon ArmSalmon ValleySalt Spring IslandSaltery BaySanspitSardisSaturna IslandSavonaSaywardSecheltSeton PortageSewell InletShalalthShawnigan LakeSicamousSidneySilver Star MountainSilvertonSimoon SoundSinclair MillsSirdarSkidegateSkookumchukSlocanSlocan ParkSmithersSointulaSookeSorrentoSouth DeltaSouth HazeltonSouth SaanichSouth SlocanSouth SurreySouthbankSouthviewSpallumcheenSparwoodSpenses BridgeSpillimacheenSpuzzumSquamishStevestonStewartStuart IslandSullivan BaySummerlandSummit LakeSunset PrairieSurge NarrowsSurreyTa Ta CreekTahsisTakla LandingTakysie LakeTappenTatla LakeTatlayoko LakeTaylorTelegraph CreekTelegraph CroveTelkwaTerraceTexada IslandThetis IslandThornhillTiellToad RiverTofinoTomslakeTopleyTrailTsawassenTulameenTumbler RidgeTwo MileUclueletUnion BayUpper FraserValemountVallicanVan AndaVanandaVancouverVanderhoofVavenbyVernonVictoriaWaglislaWalachinWardnerWareWarfieldWasaWellsWest VancouverWestbankWestbridgeWestholmeWestwoldWhaletonWhalleyWhistlerWhite RockWhonnockWilliams LakeWillow RiverWindermereWinfieldWinlawWinter HarbourWonowonWossWynndelYahkYaleYarrowYmirYoubouZeballos
*Postal Code: -
*Contact Telephone: -- (Enter as xxx-xxx-xxxx)
*Primary E-mail:
For statistical purposes, please indicate if you are: Aboriginal Immigrant - If so, how many years have you been in Canada? years.
*Would you like to receive the Women’s Enterprise Centre monthly newsletter and small business updates? Yes No
*All participants must be at least 19 years of age. Please indicate your birth date: // (Enter as DD/MM/YYYY)
*Please indicate your business start date: / (Enter as MM/YYYY)
*Indicate which phase your business is currently in: Pre Start-up – I haven’t launched my business yet. I am in the research, planning and business development stage. Start-up – I am actively operating my business and generating revenue. Early Growth Stage – My business is building momentum and I am anticipating expansion and/or increases in product/service demand.
*From what background are you transitioning into self-employment/business ownership? * - Select - Employment Other self-employment Unemployed Paid maternity leave Stay-at-home mom Disability leave Retirement Student Other If other, please explain:
*What is the highest level of formal education you have attained: - Select - Less than high school High school diploma or recognized equivalent Some post-secondary Non-university certificate or diploma such as a trades certificate University - bachelor’s degree University - above bachelor’s degree
*On a scale of 1 to 4, with 1 being low and 4 being high, how would you rate your confidence level in managing all the aspects of your business and the business challenges you are facing: one (low) two three four (high)
*What are the top three challenges that you face in developing your business? *1. - Select - Cashflow and/or budgeting Cultural challenges Marketing and/or promotion Networking Organization and administrative skills Strategic planning for business growth Understanding financial statements and/or legal documents Unstable income levels Work/life balance and/or emotional rollercoaster Other *2. - Select - Cashflow and/or budgeting Cultural challenges Marketing and/or promotion Networking Organization and administrative skills Strategic planning for business growth Understanding financial statements and/or legal documents Unstable income levels Work/life balance and/or emotional rollercoaster Other *3. - Select - Cashflow and/or budgeting Cultural challenges Marketing and/or promotion Networking Organization and administrative skills Strategic planning for business growth Understanding financial statements and/or legal documents Unstable income levels Work/life balance and/or emotional rollercoaster Other If other, please explain:
The following information about your business will assist us in placing you in the appropriate mentoring format – group or one-to-one.
*Business Industry: - Select - Hospitality Manufacturing Retail Service Wholesale
*Business Sector: - Select - Accountant Agriculture Animal care Arts Automotive Beauty Business/Office Child care Cleaning Clothing Construction trades Consulting/Contract Crafts/Hobbies Education Environmental Financial Food/Beverage Health Care Horticulture Legal Media Recreation/Leisure/Entertainment Technology Tourism Other
*Brief description of your business:
*Are you operating your business full time or part time? Full Time Part Time
*How many hours a week do you typically spend working in your business? (hours/week)
*What are your average gross monthly sales? $ (monthly sales)
*Please provide us with the top three business goals you wish to achieve:
*Which benefits do you hope to receive from participating in this program? (please choose 2) *1. - Select - Accountability Building confidence as an entrepreneur Gaining focus and setting goals Guidance and support Improving essential business skills Learning from another entrepreneur Resources/Networking Sounding board Strengthening communication skills Other *2. - Select - Accountability Building confidence as an entrepreneur Gaining focus and setting goals Guidance and support Improving essential business skills Learning from another entrepreneur Resources/Networking Sounding board Strengthening communication skills Other If other, please explain:
*The flexibility of your schedule helps us to serve you better. When are you available to meet with your Mentor (approx 2 – 3 hours)?Select all that apply: Morning Afternoon Evening Weekend
*How did you hear about Women's Enterprise Centre's Mentoring Program? - Select - Advertising An event (e.g. seminar, workshop, tradeshow.) Chamber of Commerce Community Futures Referral from government service Women in Business Network Women's Enterprise Centre Website Word of mouth Other
Please indicate if there is someone in your community who you would like Women’s Enterprise Centre to approach on your behalf to become your mentor. Name: Business: Telephone: -- (Enter as xxx-xxx-xxxx)
Please use this space to provide us with any additional comments:
WOMEN’S ENTERPRISE CENTRE
Collection and Use of Information
I have answered all questions on this form and certify that all information I have provided is complete and accurate.
I understand the Women's Enterprise Centre, through the Province of British Columbia, receives funding for this program from the federal government as a result of the Canada-BC Labour Market Agreement.
I understand that information I have provided on this form or that has been collected about me during my participation in this program will be available to the Ministry of Jobs, Tourism and Innovation who is the provincial oversight for the Canada-BC Labour Market Agreement.
I understand the Ministry of Jobs, Tourism and Innovation is responsible for fulfilling reporting obligations under section 30 of the Canada-BC Labour Market Agreement, however, no personally identifiable information about me will be exchanged with the federal government to fulfill this requirement.
I consent to being contacted by the Ministry of Jobs, Tourism and Innovation (or its agent) at intervals and up to 12 months after completion of my participation in this program for the purpose of program evaluation.
Collection and Use of Information. All information is collected pursuant to section 26(c) of the Freedom of Information and Protection of Privacy Act. The information provided will be used for administrative and evaluation purposes of this program. If you have any questions about the use of this information, contact the Manager, Skills Development, Women's Enterprise Centre (250) 868-3454.
<noframes>This web form requires that inline frames be enabled.</noframes> click here to refresh the image if you can't read it.
*Type in the validation code from the image above. It is case sensitive. <noframes>This web form requires that inline frames be enabled.</noframes>
If you would like to speak with us about this application form, or if you have any questions, please call our Mentoring Program Coordinator at Women's Enterprise Centre, 1.800.643.7014 Extension 104.
