CEO XChange for Manufacturers Application

Full Name *

Title *

E-Mail *

Phone Number *

Business Name *

City *

State *

Zip Code *

Business Website *

Year Company Started *

Legal Entity *LLCC-CorpS-CorpLPLLP

Current Number of Employees *

Ownership Percentage *

Business Description *

NAICS Code (if known)

Revenue 2023 *

Revenue 2024 *

Projected Revenue 2025 *

Are you able to make a commitment to participate in a CEO roundtable group approximately three hours/every month plus visits to your business? *YesNo

In consideration of the counselor(s) and members of CEO XChange/Florida SBDC at UCF furnishing management or technical assistance, I waive any and all claims for loss, damage or injury against FSBDC and its employees, agents, volunteer advisors and host organizations, arising from or in connection with this assistance. *

I understand an administrative fee will be due upon acceptance to the program. *

Applicant’s Initials *