Statement of Understanding
The Kansas Small Business Development Center (KSBDC) is pleased to have you as a client.
The KSBDC is a business development service for the State of Kansas. The KSBDC provides
counseling, management education, and technical assistance to Kansas businesses and would-be
entrepreneurs. The KSBDC counseling approach is one of guidance and education, not of doing
the work for the client. The quality of our assistance depends, in many ways, on you and
the information you provide. In addition to your rights as a KSBDC client, you also have
responsibilities that will help us provide you the best possible assistance.
The counseling services, which are provided to you, are part of the effort of the
constituent institutions of KSBDC to respond to the growing needs of the business community.
They are not intended to compete with, replace, or be a substitute for services, which are
available from the private sector. Clients whose needs can be fully and affordably met by
private-sector practitioners or firms will be encouraged to use those resources. It is
necessary that everyone requesting assistance have a strong personal commitment to finding
and implementing solutions to the issues and challenges facing the start-up or existing
business.
KSBDC's goal is to have an open professional relationship between the counselor and the
client.
As a new client of the KSBDC, we want to advise you of certain rights and responsibilities
that you have as one of our clients.
-
Your Rights
- Expect all communications and information be kept confidential.
- Expect courteous and professional service.
- Be advised if the KSBDC is unable to provide services within the time frame required.
- Know the counselor's name and KSBDC telephone number of the KSBDC person assisting you.
- Receive one-to-one counseling free of charge.
- Know the general nature and risks of your venture.
- Express your opinion as to the quality of assistance you received and receive a response that addresses your concern(s).
-
Your Responsibilities
- Talk openly with your counselor and provide all information necessary to enable the counselor to properly assist you.
- Make available, upon request, current financial and operating data.
- Provide information for your cash flow projections.
- Write your business plan to the best of your ability.
- Be honest and direct about everything related to you as an entrepreneur and your potential or existing business.
- Notify your counselor if you do not understand the proposed plan of action.
- Advise us of any concern or dissatisfaction you may have with the assistance being provided.
- Ask questions about anything that is unclear.
- Cooperate with your counselor and consider the recommendations your counselor may make to help you improve your business.
-
Clarification Of Our Role
- The Kansas Small Business Development Center is NOT a lending agency. Based on your input, we assist you run, analyze and critique cash flow projections for accessing capital. This type of assistance DOES NOT imply an endorsement of your proposal by the KSBDC, nor does it indicate intent to approve your loan request by any lending institution or guaranty institution, public or private. We will provide advice on techniques and sources of information needed for a financial proposal. However, it is your responsibility to collect the needed information.
- A business plan is an essential tool for every business. KSBDC counselors DO NOT write business plans; counselors will review and make recommendations to your business plan.
-
Confidential Information
- We acknowledge that clients may, from time to time, divulge confidential and proprietary information during the course of the counseling relationship. Unless otherwise expressly authorized by the client by filling out and signing KSBDC Authorization to Release Information, we will not disclose to any person or entity the identity of any client to whom we have rendered services, or any confidential or proprietary information obtained from the client and identified as such by the client. Please note the KSBDC program is a partnership program and collaboration is necessary between funding partners. The U.S. Small Business Administration (SBA) and the Kansas Department of Commerce and Housing (KDOC&H) and Kansas Colleges and Universities provide funds for the KSBDC program.
Limited information with respect to your client status (name, address, nature/scope of service, and amount of service) may be provided to those public agencies which fund the KSBDC or are responsible for auditing the financial and program performance of the KSBDC.
-
Proprietary Rights
- All patents, patent applications, trade secrets, processes, formulas and other proprietary information arising out of or resulting from the services provided to a client by the Kansas Small Business Development Center pursuant to this request shall be and remain the property of the client. The Kansas Small Business Development Center shall make no claim against a client asserting any interest in such property.
-
Business Needs Assessment
- The KSBDC counselor must develop an in-depth understanding of all aspects of your business or potential business.
It may be necessary to conduct a Business Needs Assessment of your existing business in order for our counselor to properly advise and assist you.
-
Additional Client Requirements
- You will be expected to cooperate with KSBDC in its ongoing efforts to assure the quality and effectiveness of the counseling services, which it provides. In this respect, the KSBDC will ask all clients who received counseling assistance to complete a written evaluation of the services provided. Clients may receive direct inquiries from the SBA and other public-sector agencies with respect to the services provided by the KSBDC. Your response to these inquiries is expected and will be greatly appreciated.
Since a portion of the KSBDC program funding is provided by the U.S. Small Business Administration, we are required to obtain a signed copy of the attached Request for Counseling, SBA Form 641, from all Kansas Small Business Development Center clients before providing assistance.
-
Quality Assurance
- We WELCOME you as a client and encourage you to call us if you have any questions or comments regarding your rights and responsibilities with respect to our services. You can do so by calling the KSBDC state director from anywhere in Kansas toll free (1-877-625-7232).
-
1a. Type of Client:
Face to Face
Online
Telephone
2. Office Location:
PART I: Client Request for Counseling
3. Client Name:
(name of the person completing the form/representative of the business)
4. E-mail:
5. Telephone:
6. Fax
7. Street Address/PO Box
8. City, 9. State, 10. Zip
11.
I request business counseling service
from the Small Business Administration
(SBA) or an SBA Resource Partner. I agree
to cooperate should I be selected to participate
in surveys designed to evaluate SBA services.
I permit SBA or its agent the use of my name
and address for SBA surveys and information
mailings regarding SBA products and services.
I understand that any information disclosed will
be held in strict confidence. (SBA will not
provide your personal information to commercial
entities.)
I authorize SBA to furnish relevant information
to the assigned management counselor(s). I further
understand that the counselor(s) agrees not to:
1) recommend goods or services from sources in
which he/she has an interest, and 2) accept
fees or commissions developing from this counseling
relationship. In consideration of the counselor(s)
furnishing management or technical assistance, I
waive all claims against SBA personnel, and that of
its Resource Partners and host organizations, arising
from this assistance. Please note: The estimated
burden for completing this form is 3 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.
I Agree
13. Client Signature:
PART II: Client Intake (to be completed by all clients)
14. Race: (check all that apply)
15. Ethnicity
Hispanic Origin
Non-Hispanic Origin
16. Gender
Male
Female
17. Do you consider yourself a person with a disability?:
Yes
No
18. Veteran Status:
Non-Veteran
Veteran
Service-Disabled Veteran
18a. Military Status:
Member of Reserve or National Guard
Active Duty
19. What inspired you to contact us?: (check all that apply)
SBA
Bank
Business Owner
Television/Radio
Other Client
Magazine
Internet
Newspaper
Chamber of Commerce
Education Institution
Local Economic Development Official
Word of Mouth
Other
20. Is the client currently in business?:
Yes
No
(if no, skip to question 30)
21. Name of the Company:
22. Type of Business:
(choose primary category)
Mining
Utilities
Information
Construction
Retail Trade
Manufacturing
Finance & Insurance
Wholesale Trade
Public Administration
Educational Services
Real Estate, Rental, & Leasing
Health Care & Social Assistance
Accommodation & Food Services
Arts, Entertainment, & Recreation
Transportation & Warehousing
Professional, Scientific, and Technical Services
Management of Companies & Enterprises
Agriculture, Forestry, Fishing, & Hunting
Administrative & Support
Waste Management & Remediation Services
Other Services (except public administration)
23. Business Ownership
What percentage of your business is male or female ownership?
Male
Female
24. Business Start Date
Month
Year
25. Do you conduct business online?
Yes
No
26. Is this a home-based business?
Yes
No
27. Total # of Employees
(full and part-time)
28. For your most recent business year, list your:
29. What is the legal entity of your business?:
Sole Proprietorship
S-Corporation
Corporation
Partnership
LLC
Other
30. What is the nature of counseling you are seeking? (Choose primary category)
Start-up Assistance
(How do I start a small business?)
Business Plan
Financing/Capital
(such as applying for a loan, building equity capital)
Managing a Business
Human Resources/Managing Employees
Customer Relations
Business Accounting/Budget
Cash Flow Management
Tax Planning
Marketing/Sales
(promotion, market, research, pricing, etc.)
Government Contracting
(including certifications)
Franchising
Buy/Sell Business
Technology/Computers
eCommerce
(using the internet to do business)
Legal Issues
(such as "Should I incorporate?")
International Trade
Describe specific assistance requested below.
