Entrepreneur Class Assessment Form

Please complete the following form and send it to us.

Contact Information

Given name(s)
Surname (Family name(s))
Date of birth (day/month/year)
Telephone Number
Fax Number
E-mail address
Country currently residing in
How did you hear of us?

Your business experience in the past five years

What is your current net worth in Canadian or US currency?
Name of company (list if more than one business)
Your position with the company
Dates you held this position. From to
Type of business activity or product
Your role in the daily activities
Amount of equity in the company that belonged to you (percentage)
 
Please list the company's:
number of full time employees
total annual sales
annual net income
net assets at year end
 
Are you willing and able to meet the conditions of the program by investing in a Canadian business, be actively involved in daily operations, and creating at least one full time job for a Canadian (excluding your family members)?
 
Confirm e-mail address

Please review your details prior to submission.