Valley Community Development Small Business Intake Form

Disclosures: Valley Community Development will follow strict rules to protect your confidentiality.  The personal data collected below including name, street address, email address and any other personally identifiable information is protected by the Data Privacy Act. You will never be named in any reports.  Your responses may be looked at individually by the funding source, or contractors hired by the funding source to collect and analyze data, your name or street address will not be reported.  Income, city, state, zip code, family size, and other demographic data will be reported.  Contractors of HUD/DHCD or any City/State agency are covered by the same Data Privacy Act requirements to protect your privacy and staff must demonstrate that they have systems in place to protect against data disclosure.

Contact & Demographic Information









Business Information
(If you do not have official business information, enter your personal information.)








For example: restaurant, pet groomer, acupuncture






Your gross annual income is required data needed to fund our Valley Community Development Small Business Program. Your data is only shared for reporting purposes and we prioritize our clients' confidentiality. 






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