Penn State Law Entrepreneur Assistance Clinic Submission Form

1. Describe the nature of your business—as conducted now or planned (e.g., childcare, restaurant, home repair, etc.)*

2. Types of legal services that you seek from the Clinic*

3. Names of applicants*

4. Email address for each applicant*

5. Whether a legal entity for the business has been formed, and if so, the name of the entity*

6. Whether the business had any revenue in the current year or previous tax year*

7. Geographic location (county) of the applicants and the business*

8. Any connection to Pennsylvania (e.g., resident) or to Penn State (e.g., alumni, faculty, student, staff, etc.)*

9. Whether the applicants are students, and (a) if so, what schools, and (b) if at Penn State, what colleges and campuses within Penn State*

10. Whether you are working with a PA Small Business Development Center ("SBDC")*

yes
no

10(a). Specify which SBDC*

11. Any participation in programs at a PSU LaunchBox?*

yes
no

11(a). Specify which LaunchBox / Innovation Hub*

12. How did you hear about the Clinic (e.g., referral by an SBDC, Smeal, economic development group, another client, etc.)*

13. SPECIFY which, if any, of the following categories may apply to you: company owned and controlled by woman, person of color, LGBTQ+, veteran, or disabled individual. (We record this information to advise whether applicants or the clinic may qualify for governmental programs available to diverse business enterprises.)*

Veteran status?*

yes, one or more of applicants are veterans
not applicable

check this box if any of the business owners are veterans (Department of State offers fee waiver for company formation)

14. Whether the applicants are US citizens or permanent residents (this relates to potential visa issues)*

15. Whether the applicant has been or is being advised by other lawyers with respect to the current business?*

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