Name*

Address*

City*

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip*

Phone*

E-mail*

Which of the following most accurately describes your profession or planned profession?*

Engineer Healthcare Utility Education Legal Finance

Accounting Retail Manufacturing Government Student Other

If you chose other, please list your profession.

Do you hold one of the following degrees from an accredited higher learning institution?*

Associate's Bachelor's Post-graduate Technical Degree Other No Degree

Please check the box next to your academic discipline.*

Engineering Nurse Medical Business Education Agriculture Humanities

Vocational Culinary Arts Law Sciences Other

If you answered other, please list your degree.

Are you interested in starting a business?*

Yes

No

ROZ Counties in which you are most interested.*

Note: Each county has different tuition reimbursement budgets. To date, we have seen great interest in certain Kansas counties, including Chautauqua, Cheyenne, Cloud, Graham, Harper, Hodgeman, Jewell, Kingman, Kiowa, Lincoln, Marion, Mitchell, Pawnee, Pratt, Rawlins, Rooks, Rush, Russell, Sherman, Smith, Thomas, Trego, Wilson and Woodson. Due to the program’s popularity in these counties, waiting lists have been established. However, funding remains available in a large number of counties. Please keep this fact in mind as you are considering program participation.

Please explain in as much detail as possible what information you're requesting.*

Where did you hear about the Rural Opportunity Zones Program?*