CNPP Inquiry Name First Last Email Enter Email Confirm Email PhoneBusiness Name (if applicable) If you are uncertain of the name, please enter “TBD”. Business Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Brief Description of Your BusinessPreferred Contact method Email Phone Race (check all that apply) American Indian or Alaska Native White Black or African American Native Hawaiian or Other Pacific Islander Asian Prefer not to say Prefer to self-describe What is your gender identity? Female Male Nonbinary Prefer not to say Prefer to self-describe Do you consider yourself a person with a disability? Yes No Do you identify as (check all that apply) Intersex Transgender Both Neither Prefer not to say Prefer to self-describe Do you identify as Bisexual Gay/Lesbian Heterosexual Prefer not to say Prefer to self-describe Military Service (check all that apply) No Military Service Veteran Spouse of Military Member Active Duty Service Disabled Veteran Ethnicity Hispanic or Latino Not Hispanic or Latino Prefer not to say Prefer to self-describe YOUR LEGAL NEEDS Check here if you have attended an event to obtain assistance for a flood-related matter.Describe your legal need: I have a legal need related to impact from the July 2023 floods. I have a legal need that can be addressed in a half-hour phone call. I have received a legal communication or document that requires a time-sensitive response. I have a legal need that I would like to address in the next few months. I have a legal need that involves an ongoing damage or harm. I would like to explore legal questions as I am starting or growing my business. My need is not urgent. How can we help with your legal questions?How did you hear about us?Please tell us the name of your business advisor, if you have one. Business advisor's email (to invite them to the educational consult): BUSINESS DETAILS Please help us by providing these details to assist us with your grant processingBusiness Entity Type (please choose one) Sole Proprietorship S-Corporation Corporation LLC Partnership Other Business Open Date MM slash DD slash YYYY Number of Part-Time EmployeesNumber of Full-Time EmployeesType of BusinessMiningUtilitiesInformationConstructionRetail TradeManufacturingFinance & InsuranceWholesalePublic AdministrationEducational ServicesReal EstateRental & LeasingHealth Care & Social AssistanceArtsEntertainment & RecreationTransportation & WarehousingProfessionalScientific & Technical ServicesManagement of Companies & EnterprisesAgricultureForestryAdministrative & SupportWaste Management & Remediation ServicesOther Services (except Public Administration)Do you conduct business in a language other than English? Yes No EmailThis field is for validation purposes and should be left unchanged.
