HigherSelf Small Business Partner
Application
Providing valuable products or services to the community
Your Personal Information
First Name
*
Last Name
*
Prefix
Please Select
Mr.
Ms.
Mrs.
Phone
*
Your Organizational Title
*
E-mail Address
*
I. Small Business Information
Name of Business
*
Business E-mail
*
Phone
*
Website
Business Address (if online, write "online" into the box below)
*
Borough
Please Select
Brooklyn
The Bronx
Manhattan
Queens
Staten Island
Zip
II. Small Business Information
What kind of small business are you applying on behalf of? Briefly describe the type of products or services this business is providing to the community. example: "this business is a salon, and we make people look great!"
What this business" mission?
Aside from its day to day sale of products or services, how else does this business benefit the community it calls home? example: "this restaurant donates leftover food to the local shelter!"
Is this business owned by a woman, or a person of color?
*
Women-Owned
Minority-Owned
Both
Neither
How many people are on employed by this business?
*
1
2-5
6-10
10+
What percentage of employees live within 2 miles of this business?
*
0% - 20%
21% - 40%
41% - 60%
61% - 80%
81% - 100%
Additional Comments
How did you learn about HigherSelf?
A friend
A HigherSelf event
Social media
Through a volunteer
I don't remember
Would you like to subscribe to our newsletter?
*
Yes
No
Thank You!
Submit
Should be Empty: