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Cox Communications Small Business Growth Academy Registration and Assessment Form
Cox Communications Small Business Growth Academy Registration and Assessment Form
If you see this don't fill out this input box.
General Information
Business Name
*
Business Owner's Name
*
Business Address
*
Business Phone Number
*
Email Address
*
Business Website Address
*
Are you a current vendor of Cox Communications?
Yes
No
Are you a Cox Communications business customer?
Yes
No
Please select your service type.
Construction
Professional Services
Goods & Services
Please select your business structure.
Limited Liability Company
Corporation
S Corporation
Sole Proprietorship
Partnership
Cooperative
Please select the Parish(es) in which your business is domiciled.
*
Orleans
Jefferson
St. Bernard
St. Charles
St. John the Baptist
St. Tammany
Terrebonne
Tangipahoa
East Baton Rouge
Plaquemines
Other
If other, please specify.
Capacity
Does your business have a Federal Tax ID Number?
Yes
No
If yes, please enter.
Is your business registered to do business in the State of Louisiana?
Yes
No
Does your business have an Occupational License?
Yes
No
Does your business employ more than three full-time employees?
Yes
No
Has your business successfully completed five or more contracts as a prime contractor or subcontractor?
Yes
No
Is your business bonded and/or insured?
Yes
No
Does your business follow a defined set of procedures in its strategic planning process?
Yes
No
Does your business have a written mission statement?
Yes
No
Does your business have written long-term and short-term goals?
Yes
No
Does your business decide its strategic plan(s) based on feasibility and risk/return criteria?
Yes
No
What are your current needs for business assistance?
*
Areas of Leadership
Do you have a clear one, three, and five-year vision for your company?
Yes
No
Have you identified measurable goals that support your company's vision?
Yes
No
Certifications
Is your business certified as a State and Local Disadvantaged Business Enterprise (SLDBE)?
Yes
No
Is your business certified as a Disadvantaged Business Enterprise (DBE) minority business enterprise (MBE) through the Louisiana Unified Certification Program (LAUCP)?
Yes
No
Does your business hold any other certifications?
Yes
No
If yes, please list those certifications.
Form UUID
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