Request for Counseling Form

The Small Business Institute®
Field Case Studies Programs

College of Business Administration
University of Cincinnati

Please fill in the following fields and then press the button at the bottom to submit.
Name of Company

Your Name

Telephone       Fax

Email

Company Address
City State Zip

Web Site URL?

Are you currently in business? yes no  
If yes, how long?

Type of Business (check all that apply)
Retail                Manufacturing      Service       Dot-com 
Construction     Wholesale            Not in Business  Not for
                                                                                                         Profit

Number of employees:      Full time      Part time

Brief Description of Business:


How did you find out about our program or who referred you to us?
Can your provide a recent:     Balance Sheet?        yes no
                                                  Income Statement?  yes no

IMPORTANT!  Please read before submitting application:
I request to be considered for participation in the field case studies program and/or the Small Business Institute® Program at the University of Cincinnati.  I understand that all information provided will be held in strict confidence by the participants of the program.  I further understand that student team members agree not to: (1) recommend goods and/or services from sources in which he/she has a direct or indirect interest; and (2) accept fees or commissions for the duration of the field case project.  In consideration of my participation in this teaching/learning relationship, I waive all claims against the University of Cincinnati, University of Cincinnati personnel, student team members, the Small Business Institute program, and any host or sponsoring organizations arising from this project.
By submitting this form, I agree to the terms stated above.

If submission does not work, please print out form and fax or mail to Dr. Charles H. Matthews, Director, SBI Program, College of Business Administration, University of Cincinnati, Cincinnati, OH  45221-0165, phone: 513-556-7123; fax: 513-556-4891; email: ecenter@uc.edu