Worthy Entrepreneurship Intake form

“Building Business with Purpose & God-Given Vision”

First name

Last name

Phone

Email

Faith & Purpose Alignment

Do you identify as faith-based ?

Yes

No

Open to faith-based guidance

How does your faith influence your desire to start or grow a business ?

What scripture, belief, or principle currently motivated you in this season ?

Are you currently:

Aspiring Entrepreneur ( Idea Stage)

New Business Owner (0-1 year)

Growing Business Owner (1-3 Years)

Established Business Owner (3+years)

Business Name ( if applicable )

Type Of Business Industry

Do you currently have:

LLC/ Registered Business

EIN

BUSINESS BANK ACCOUNT

NOT YET

What is your God given vision for your business ?

What are your top 3 goals for the next 6-12 months?

what challenges are you currently facing in your business or idea?

Have you ever worked with a mentor or coach before ?

Yes

No

On a scale of 1-10, how committed are you to building your business with discipline and faith?

Are you open to prayer, biblical principles, and accountability as part of this program ?

Yes

No

Unsure but open

Is there anything else you would like us to know about you or your journey?