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1. Name of Office Providing the Service: _________________________ City/ State _______________
  

2. Organization 
 SBDC                   	 WBC     
 SBA District Office	 SCORE, Chapter No._______
 Other (specify) ________________
3. Date Training Started (m/d/y)
4. No. of 
    Sessions 
5. Total Hours 
    of Training
6. Title of Training

7. Location of Training
    
City ___________________________ State__________ Zip _____________

+4
___________

8. Total Number Trained  __________
9. Total Number of Minorities 
Trained ____________

_______ Currently in Business

_______ Not Yet in Business

_______ People with Disabilities

­_______ Women



________ Total Veterans

________ Service-Disabled Veterans

_________Members of Reserve or National Guard 


(please complete to the extent information is available)

Race (mark one or more)
________ Asian
_________ Black or African American
_________ Native American or Alaskan Native
_________ Native Hawaiian or Other Pacific Islander
_________ White

Ethnicity

________Hispanic Origin
________Not of Hispanic Origin
10. Training Topic (check primary topic) 
	 Business Start-up/Preplanning
	 Business Plan
	 Business Financing/Capital Sources
	 Managing a Business
	 Human Resources/
            Managing Employees
	 Customer Relations
	 Business Accounting/Budget
	 Cash Flow Management
	 Tax Planning
	 Marketing/Sales
	 Government Contracting
	 Franchising
	 Buy/Sell Business	
	 Technology/Computers
	 eCommerce
	 Legal Issues
	 International Trade
		 Other (Specify) 

      __________________________________
11. Resource Partners Participating (check all that apply)
	 SCORE
	 SBDC
	 Women's Business Center
	 VBOC
	 Educational Institution
	 Chamber Of Commerce 
	 Trade Or Professional Assoc.
	 For-Profit Organization
	 Online Training Resource
	 SBA District Office
      Native American Center
	 SBA (specify office)
    _______________________________
	 Other Govt. Agency (specify)

    _______________________________

	 Other (specify)

    _______________________________
12. Program Format (check only one)
	 Seminar/Workshop (short-term training on business-related subjects that is conducted as a single, stand alone program)
	 Course (more formal structured training on business-related subjects that may be conducted over a number of sessions)
   	 Online Course (a formal structured training delivered via the Internet)
	 Teleconference (any training delivered via electronic communications, except Online Course)
13. Attendee Fee

Full Fee              _____________ x $__________ = $__________
                          (no. of attendees)     (fee per attendee)
Discounted Fee ______________ x $__________ = $__________
No Fee              ______________ x $____0_____ = $_____0____
No Show Income_____________x$___________= $__________
Other Income                                                           =$__________

                              14. Total Gross Fee Income $__________
15.  What is the dollar amount of fees that your organization received?

16. Language(s) Used

	 English      	 Spanish  	 Other (specify) ________________________
17. Name of Sponsor
18. Name of Co-sponsors (if applicable)

_____________________________________________________              ___________________________________________________________________
Please note:  The estimated burden for completing this form is 10 minutes.  You are not required to respond to any collection information unless it displays a currently valid OMB approval number.  Comments on the burden should be sent to: U.S. Small Business Administration, 409 3rd Street, SW, Washington, DC 20416, and to: Desk Officer SBA, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C., 20503. OMB Approval (3245-0324). PLEASE DO NOT SEND FORMS TO OMB.

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