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Did your company receive PHDC services? *
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Inquiry information
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Is your company on the list? *
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Personal information
First Name *
Middle Name
Last Name *
Second Last Name
Birthday *
Phone Number *
Email
Address *
Optional Address Notes
Extra Personal Information
You are *
Latino
Latino Descent
Other
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Gender *
Famale
Male
Others
Level of English *
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Do you have a Pennsylvania ID?*
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No
Do you have any disabilities?*
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No
Prefers not to say
Origin Country *
Date of entry to the United States *
Used only for statistical purposes
Estimated date of arrival to Pittsburgh *
Used only for statistical purposes
Family members under 18 *
How many members of your direct family living in your house are under 18 years old?
Adult family members *
How many members of your direct family living in your house are adults?
Estimated monthly household income *
Is your company already registered? *
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No
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Company information
Company Name *
Name registered (Add LLC if applicable).
Phone Number *
Email
Address *
Optional Address Notes
Webpage
Industry *
Construction (Drywall, Electricity, Painting)
Cleaning
Food (Bakery)
Landscaping (Greenhouse)
Hospitality
Retail (Sales)
Beauty (Consmetology, Hair Salon)
Automotive (Automobile)
Entretainment (Recreation, Events)
Transportation
Travel Agency
Real Estate
Consulting (Digital Services, Online Consulting)
Marketing (Advertising)
Art Craft
Other Category
Women Owned? *
Yes
No
Origin Country *
Owner Birthday *
Foundation Date *
How is your Business organized? *
I am the Business Owner
Profit association
Corporation
Limited Liability Company (LLC)
Non-profit organization
Does your Business have ownership of Intellectual Property (IP)?
No IP
The owner is someone else
The owner is a University
Shared ownership
I need help to obtain IP
Not apply
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Business Idea information
Company Name *
Industry *
Construction (Drywall, Electricity, Painting)
Cleaning
Food (Bakery)
Landscaping (Greenhouse)
Hospitality
Retail (Sales)
Beauty (Consmetology, Hair Salon)
Automotive (Automobile)
Entretainment (Recreation, Events)
Transportation
Travel Agency
Real Estate
Consulting (Digital Services, Online Consulting)
Marketing (Advertising)
Art Craft
Other Category
At what stage is your Business? *
Conceptual
Prototype
Product or Service Developed
Other
If you selected other, please mention it
Women Owned? *
Yes
No
Origin Country *
Owner Birthday *
How is your Business organized? *
Not started yet
I am the Business Owner
Profit association
Corporation
Limited Liability Company (LLC)
Non-profit organization
Does your Business have ownership of Intellectual Property (IP)?
No IP
The owner is someone else
The owner is a University
Shared ownership
I need help to obtain IP
Not apply
Describe your Business model including products and services *
What are your current challenges or needs? *
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Inquiry information
What are your needs? *
Cublicle
Shared room
Meeting room
Training room
Business idea analysis
Business plan
Business Relocation
Website
Advisory
Other
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