Economic Development Intake Form

Today's Date *

Format: M/d/yy

Name of Business *

Address of Business

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Phone Number *

Email Address *

Preferred Contact Method *

Phone Email

Name of Business Owner *

Name of Business Operator (if different than owner)

What are your current business goals?

Maintaining my business Expanding my business Site Change/Relocation Employee Retention Workforce Training

Select all that apply.

Are there other business goals not listed above?

What industry does your business align with?

What is your filing status?

For Profit Non-Profit

Does your business identify with any of the following categories?

Veteran-Owned Women-Owned Minority-Owned Person with a disability Owned LGBTQ-Owned Small Business Certified

Select all that apply

Do you like doing business in Carbon County? If so, what is going well? If not, what barriers impact your business?

Referral Programs

Below are programs offered through the CCEDC along with local and state agencies. Please select the programs below you are interested in learning more about.

The CCEDC, in partnership with the CCIDA (Carbon County Industrial Development Authority), offers multiple funding options to businesses located in Carbon County. Please select any of the options below to be provided with more information from our Economic Development Specialist:

Small Business Revolving Loan Program Pennsylvania Industrial Development Authority (PIDA) Loans) Local Share Account (LSA) Grants Pennsylvania Economic Development Financing Authority (PEDFA) Bonds Redevelopment Assistance Capital Program (RACP) Grants

Select all that apply

Would your business benefit from community education available to support employees and customers with mental health and/or developmental disabilities? *

Yes No

A second chance employer is a company that actively hires individuals with criminal records, providing them opportunities to reintegrate into the workforce and society. Would you like to learn more about benefits associated with becoming a second chance employer? *

Yes No

The APEX Accelerator helps large and small businesses pursue and perform under contracts with the Department of Defense, other federal agencies, state and local governments and with government prime contractors. Would you like to learn more about the APEX Accelerator Program? *

Yes No

Would you like to speak with someone to create or revise a business plan? *

Yes No

WEDnetPA provides qualified employers training funds for new and existing employees. Would you like to learn more about WEDnetPA? *

Yes No

Penn State PennTAP provides technical assistance to businesses in the areas of energy efficiency, pollution prevention, technology commercialization and more. Would you like to learn more about Penn State PennTAP? *

Yes No

PA 529 accounts help families save for future educational expenses at qualifying technical, collegiate and apprenticeship programs, as well as some K-12 expenses. A Pennsylvania employer tax credit is available for employers who match contributions to employees' 529 accounts. Would you like to learn more about PA 529? *

Yes No

The Pennsylvania Historic Preservation Tax Credit (HPTC) provides tax credits to qualified taxpayers who will be completing the restoration of a qualified historic structure into an income producing property. Would you like to learn more about the HPTC Program? *

Yes No

Are there any programs or business needs, not mentioned above, you would like to obtain more information on?

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