Please complete the following application and click once to submit. Personal Information* indicates required field First Name * Middle Name Last Name * Maiden Name Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Home Phone Email Business Information Business Name Form of Ownership Business Website/URL Currently Enrolled at MCC?YES NO Student ID - last 4 only Has the applicant completed, or is currently enrolled in MCC business courses? Please select all that apply GBS151 MGT253 EPS195 MKT271 MKT110 MGT174 MKT110 MGT174 SBS204 SBS230 If none, please briefly explain why you feel you have the business acumen to own and operate a business at this time. Briefly describe your business venture including a description of your product or service. Business to be based in Mesa? Yes No Do you currently have a business plan? Yes No File Attachments Please attach your Business Plan below. File Attachment_1 Attach another file Understanding & Acknowledgement I Agree Participants accepted in Green Flag Mesa will be required to pay a $50.00 key deposit. Keys will remain the property of Mesa Community College and must be returned upon request. Participants agree that the keys provided are personal property and are not to be shared or loaned to other persons. I Agree Access to Green Flag Mesa will be 24 hours a day. Participants acknowledge that during late night hours there is no building security and participants accept all personal risk associated with entering and leaving the building. Exterior doors must remain secure at all times. When entering and leaving exterior doors; re-lock immediately. I Agree Participants acknowledge that Green Flag Mesa is a shared workplace. While participants will be provided a secure file cabinet for personal items, participants understand and agree that personal items left unattended are at their own risk and Green Flag Mesa assumes no liability for personal or intellectual property not adequately secured. I Agree Participants will have limited use of the facility. A monthly use fee of $10.00 will be charged on the first day of each month to cover incidental costs (copy supplies, coffee...) I Agree Participants are tenants of Mesa Chamber of Commerce and agree to respect the space provided in a professional business manner and will abide by the rules established by both Mesa Community College and the Mesa Chamber of Commerce. I Agree Participants may have access to Green Flag Mesa for 12 months from the date of the signed agreement. Renewal will require a new application with consideration and approval of the mentor review board. As a tenant of the Mesa Chamber of Commerce and a student at Mesa Community College I understand the above terms and conditions and understand that if I am accepted as a participant in Green Flag Mesa I will abide by these terms and conditions. Please type your First and Last Name in the box provided. I understand that typing my name in this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.