My Start-Up: Participant Registration Form

Section A: Applicant Information

Program Start Date

Applicant Full Name

Contact Number



Postal Code

Date of Birth

Age Group

Emergency Contact

Contact Number

Employment Status

Source of Income


Education History

Immigration Status

Do you have a valid S.I.N Number?

Referral Source


Section B: Business Overview

Tell us about your business or business idea. Please provide as much detail as possible regarding your business.

Do you have access to a computer?

Business Status

Industry Sector


Business Idea

What would be your product or service?

Who will be your customer?

Where would your business be located?

Are you interested in applying for low-interest business loan

What do you want to learn from this program?

Why have you not started a business?

Are you interested in participating in additional training if available?

Do you self-identify as a member of a designated group(s)?

We will be sharing this information with our funder, for the purpose of assessing and evaluating the effectiveness of our programs and services. Check all that apply.

Additional Information you would like to share.

Sometimes the company we keep can have serious, everlasting consequences that alter the course of our life. Charlie found out the hard way that her partner did not have the best of intentions after she was arrested for holding on to his gun. Luckily, Charlie was strong enough to turn her situation around.  Charlie took full advantage of programs available when she was at Grand Valley Institute, and that hard work paid off upon her arrival to the Phyllis Haslam Residence at Elizabeth Fry Toronto. 

Upon her release, Charlie had a job lined up in a field she was passionate about, and has been working hard to save money so she can support herself when she is granted her full parole. Most importantly, Charlie has reconnected with old friends. By surrounding herself with positive influences who are as invested in her success as she is, it reminds Charlie that life always moves forward.