Contact the Belin Economic Justice Project

Small Business Intake Downloadable Version:

EJP General Intake Form (English)
EJP General Intake Form (Spanish)

Personal Information

Name

Home Address

Phone Number

Email Address

Sex

Race/Ethnicity

Is English your first language?

Are you currently a U.S. Citizen?

Do you have a disability or chronic health condition that significantly limits any of your daily activities or the kind or amount of work you can do?

Business Information

Name of your new or existing business

Briefly describe your business or business idea? (e.g., the type of services and products your business offers)

Business Email Address

Mailing Address

Business Phone Number

Do you have any entrepreneurial training or experience?

What community will you, or do you presently, serve with your business and what benefits will the community receive, if any? (For example, will your business hire employees from the community?)

Are you currently conducting business?

How many people work for your business?

How many people do you anticipate hiring over the next 3 years?

How did you hear about Lawyers' Committee?

Financial Information

*Please upload a copy of your most recent yearly tax return

How many people in your household?

How many are dependents?

What is the total annual gross income from all members of your household?

What is your gross annual income?

What is the source of your income?

Is your business being financed in part or in full by a source other than yourself?

Have you applied for any loans to finance your business?

Do you have any partners in your business?

Do you have other significant financial obligations (such as child care, educational expenses, child support or alimony that would assist us in evaluating your application)?

Legal Business Assistance

What legal services do you think you need?

Has an attorney helped you with your business at any time?

Have you received assistance from an organization on starting your own business(e.g., business plan, marketing, financial management)?

Have you ever applied to the Lawyers' Committee before?

Lawyers’ Committee for Civil Rights and Economic Justice

  • Phone: (617) 482-1145

  • Fax: (617) 482-4392