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Application for Operation JumpStart Fall 2016 Session


_______________    _________________________     _________________________     ______________

Date                                          First Name                                    Last Name                          Date of Birth



Street Address


____________________________      _______           _____________       ____________________

City of Residence                                      State                    Zip Code                        County


_________________           _________________________            ___________________________

Home Phone Number                     Cell Phone Number                                Email Address


________________________                  Can you receive calls at work?    Yes     No 

Work Phone No


Class location is the Keeton Room in the Industrial Technology Complex on the Grenada campus of Holmes Community College.


Present employment status?       Dislocated workers check the last box and give company information.

Full Time (more than 35 hrs/week)          Seasonal Employment

Part Time                                                Unemployed less than 6 months

Full Time Self Employed                       Unemployed more than 6 months 

Part Time Self Employed                          Unemployed more than 2 years

Dislocated worker    

   What company_______________________ In what city is this company located?__________________


Have you ever operated a business?    Yes No

Do you currently operate a business?  Yes No  


 Business name:_____________________________________________________


Which of the following apply to you? (Choose as many as you like)

Trying to decide if business ownership is right for me, or if my business idea is viable,  

     through the development of a plan.                                                                                                                                                                                                                                     

Need assistance and/or capital to stabilize my existing business.

             Need assistance and/or capital to expand my existing business.

Other(specify)  __________________________________________________ 


What are your expectations for the amount of annual income (salary you pay yourself, profits, or other funds that are used for household expenses) from your business that you will be able to take next year?  ___________________________________________________________


Send Completed Operation JumpStart application to:

Grenada County Economic Development District
2000 Gateway St., Suite 140
Grenada, MS  38901

Program Cost is $85 / includes textbook and class materials