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Entrepreneurship Training Workshop Confidential Application Form
1.Workshop:
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

8.Have you ever been an apprentice? Yes No
9.Organization/Person:

10.Did your father or mother ever own their own business? ? Yes No

If yes, did you work in the business? Yes No

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

12.Did any of your friend's fathers or mothers own their own business? Yes No

13.How many people do you know well personally who own their own business?

14.Were you the first child born in your family? Yes No

15.Have you traveled outside of your country? Yes No

If yes, list the countries where you have traveled most frequently and how many times have you traveled to each
Country








 Number of Times
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?


Please list your past work experience below, with your most recent job first:
Employer Address Phone Position Dates


















































17.Have you ever tried to start your own business? Yes No

What kind of business?

What happened to this business?

18.Are you presently in business for yourself? Yes No

What kind of business?

19. If you intend to start a business or expand your current business, what kind of business will you start/expand? (Please give details)

20. If you do not intend to go into business right away, how do you intend to make use of this entrepreneurship training?

21. How much capital do you think you will need to start up or expand your business?

22. 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:

23.Do you own your own home, apartment or land? Yes No

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

25.Do you agree or disagree with the following statement? “It is more important for a job to offer opportunity than security.”
Agree Disagree

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.

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

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:

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

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

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%

Please explain why this is the case.
32.Are you willing to spend two uninterrupted weeks in the course?? Yes No

33.How did you hear about this program?

34.What other entrepreneurship or business development workshops or courses have you attended? Please give dates.
Course Date








35.Describe your business or ideea/project of business:

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