{1}
##LOC[OK]##
{1}
##LOC[OK]##
##LOC[Cancel]##
{1}
##LOC[OK]##
##LOC[Cancel]##
Account Options
Sign out
Ibero Business Center
Request Information
Request Programs
Select the programs the applicant is considering.
Ibero Business Center - Capital Region
Ibero Business Center - Finger Lakes
Ibero Business Center - Rochester
Ibero Business Center - Western New York
Applicant Contact Information
Enter contact information for the primary applicant
Email:
Phone:
Alternate Phone:
Address 1:
Address 2:
City:
State:
--Choose One--
--Choose One--
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
U.S. Virgin Islands
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
County:
--Choose One--
--Choose One--
ZIP code:
Applicant Name
Identify the primary applicant
Salutation:
None
None
Dr.
Miss
Mr.
Mrs.
Ms.
First:*
Middle:
Last:*
Suffix:
Date of Birth:
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
<<
<
August 2025
>
<<
August 2025
S
M
T
W
T
F
S
27
28
29
30
31
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1
2
3
4
5
6
Other Information
Enter as much information below as possible. Fields that say 'required' or have a blue bar are required.
Preferred Language/Idioma preferido
Preferred Language/Idioma preferido
(Text)
English
Espanol
Thinking of starting your own business?/Pensando en comenzar su propria empresa?
Stage of Business/Etapa de Negocio
(Text)
Thinking of Starting a Business/Pensando en comenzar un negocio
In Process of Starting or Acquiring a Business/En proceso de iniciar o adquirir un negocio
Currently own a business that has been in operation for less than 1 year/Actualmente dueño de un negocio que ha estado en funcionamiento por menos de 1 año
Currently own a business that has been in operation for 1 to 5 years/Actualmente dueño de un negocio que ha estado en funcionamiento durante 1 a 5 años
Currently own a business that has been in operation for more than 5 years/Actualmente dueño de un negocio que ha estado en operación por más de 5 años.
Business Saved/negocio salvado
Business Idea/Idea de negocio
(Text)
What technical services are you interested in?/¿Qué servicios técnicos te interesan?
Technical services/Servicios técnicos
(Text)
Business Start-up/inicio de negocio
Preparing a Business Plan/preparar un plan de negocios
Creating a Financial Plan/Creación de un plan financiero
Creating a Marketing Plan/Creación de un plan de marketing
E-Commerce/Website Development/Comercio electrónico/desarrollo de sitios web
Managing a Business/administrar un negocio
Legal Structure/Estructura legal
Sources of Capital & Funding/Fuentes de Capital y Financiamiento
Home-based Business/Negocio desde casa
Accounting & Recordkeeping/Contabilidad y mantenimiento de registros
Mentorship & Business Coaching/Tutoría y Coaching Empresarial
Applying for Grants & Loans/Solicitud de becas y préstamos
MWBE Certification/Certificación MWBE
Other/otro
Interested in the Business Start-Up Class?/¿Interesado(a) en la clase de inicio de negocios?
Business Start-Up Class/Clase de creación de empresas
(Text)
Yes/Si
No/No
Thank You
Upload Files
File
Link
Use the 'Select' button to browse for a file, or use your mouse to drag a file and drop it onto the selection box, then click 'Upload'. If you change your mind, click 'Remove' to deselect the file.
or drag file into the top part of this gray zone
Enter a link in the text box above.
If external to IMPOWR, then include the https: or http: prefix. Example:
https://www.google.com
If internal to IMPOWR, then include "..\Forms\" prior to the page name. Example:
..\Forms\Boards
Revision #:
Revision Name:
Revision Date:
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
<<
<
August 2025
>
<<
August 2025
S
M
T
W
T
F
S
27
28
29
30
31
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1
2
3
4
5
6
RadDatePicker
RadDatePicker
Open the time view popup.
Time picker
Time Picker
12:00 AM
12:30 AM
1:00 AM
1:30 AM
2:00 AM
2:30 AM
3:00 AM
3:30 AM
4:00 AM
4:30 AM
5:00 AM
5:30 AM
6:00 AM
6:30 AM
7:00 AM
7:30 AM
8:00 AM
8:30 AM
9:00 AM
9:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
3:30 PM
4:00 PM
4:30 PM
5:00 PM
5:30 PM
6:00 PM
6:30 PM
7:00 PM
7:30 PM
8:00 PM
8:30 PM
9:00 PM
9:30 PM
10:00 PM
10:30 PM
11:00 PM
11:30 PM
Expiration Date:
RadDatePicker
RadDatePicker
Open the calendar popup.
Calendar
Title and navigation
Title and navigation
<<
<
August 2025
>
<<
August 2025
S
M
T
W
T
F
S
27
28
29
30
31
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1
2
3
4
5
6
Revision Information:
Electronically Sign
Signing as:
Enter Login or email address:
Enter Password:
Audit Findings
Comment:
Findings:
Finding
Category
Severity
Urgency
Recommendations
Substance Usage
Substance Type
Frequency
Route
Criteria
Reported By
Last Date of Use
Diagnosis Codes
Code
Diagnosis
Modifier
© 2025 by Continual Care Solutions, Inc. All Rights Reserved.
Ver: 1.3.47.06
Terms of Use
Privacy Policy