Web Address

1. How did the client learn about CESO?

Personal contact
Business contact
Media
Other (describe):

2. Describe ownership of the business:

Year established:
Band
Individual
On Reserve
Private
Partnership
Off Reserve

3. Has client ever received CESO assistance?
Yes   No

4. How many employees does the organization have?
          Male   Female 

5. Employees under 30 years of age
          Male   Female

6. Yearly sales over the last three years (if applicable)

Less than $20,000
$20,000 to 49,999
$50,000 to 99,999
$100,000 to 249,999
$250,000 to 999,999
Over $1,000,000

7. Size indicators:

If a service company, how many customers/clients are there?

If an association, how many members are there?

Please identify other size indicators:

8. From the following list, indicate your type of business or organization:

Agriculture
Band Government Services
Business Services
Communications
Educational Services
Financial Services
Health Services
Hospitality
Manufacturing
Resource Development
Social Services
Tourism
Other – describe:

9. What prompted the request for assistance? Please be specific.

10. What does the client want the Volunteer Adviser to do?

11. Identify the results expected from the assistance provided by the Volunteer Adviser.

12. Has the project received approval from chief and council, board of governors, or others?

Yes  No  Please explain:

13. Are funds available for the project/venture?

Yes  No  Please explain:

14. Please indicate one of the following that pertains to you:

First Nation
Inuit
Métis
Other

15. Please indicate which band you are affiliated with:

16. Please indicate which tribal council you are affiliated with:

This form was completed by: