Full Name *
Title *
E-Mail *
Phone Number *
Business Name *
Business Address *
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. *
Initials *
1 + 7 = ?Please prove that you are human by solving the equation *
* = denotes required fields.