U.S. Small Business Administration Counseling Information Form

REQUEST FOR CONSULTATION
31. Date Counseled (MM/YYYY) 32. Language(s) Used:
English Spanish Other (specify)____________
33. History
New Case Follow-up One Time
34. Counselor(s) Name (If multiple counselors, list lead counselor first and separate
each additional counselor name by a semi-colon):
35a. Contact Hours 35b. Prep Hours
35c. Travel Hours Total amount of time it takes to travel to a client’s location for counseling. Miles ______ Hours________
36. Referred Client to (Mark all that apply): ITAC MTSBDC PTAC MEP/Technology
WBC SBA District Office Export/Import Bank Dept of Commerce Export Assistance
SCORE USEAC OPIC Dept of State Other_________________
SESSION NOTES -- STRATEGIC COUNSELING FORMAT
Initial Session:
The INITIAL SESSION with a client MUST include the following documentation in the notes field in Center IC in the following order:
1. DESCRIPTION of the client’s business – short, concise and thorough.
2. ANALYSIS/statement of the problem(s) to be solved.
3. SESSION SUMMARY/ACTIONS TAKEN of what occurred in the session (discussion talking points, brainstorming, etc.)
4. PLANNED ACTIONS/NEXT STEPS to be taken prior to the next session to address the problem (spreadsheet developed, assessment performed, business plan
outlined, etc.)
5. GOALS set for the client and the business advisor to achieve overall objectives.
DID YOU COMPLETE THE BASELINE ECONOMIC INDICATORS? Yes No
Follow-on Session:
The FOLLOW-ON SESSIONS with a client MUST include the following documentation in the notes field in Center IC in the following
order:
1. PROGRESS made since the last session on actions assigned.
2. SESSION SUMMARY/ACTIONS TAKEN of what occurred in the session (discussion talking points, brainstorming, review of business plan draft, etc.).
3. PLANNED ACTIONS/NEXT STEPS plan to move forward, the next steps for the client and the business advisor.
4. GOAL UPDATES includes any updates or revisions to the goals set in the initial session.
5. DOCUMENTS attached any electronic files as well as indicate what paper documents were added to the client’s file.
DID YOU ADD ANY NEW ECONOMIC INDICATORS? Yes No
Ohio Client Intake Form 641 3
Updated: 03/2013