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Thank you for your interest in the Be Your Own Boss programme.

Please complete this form so we can understand your needs and how best to support you.

Section 1: Personal Details

Section 2: Support Service Involvement

Section 3: Reference Details

Section 4: Your Interest in the Programme

Section 5: Declaration

First Name*

Last Name*

Email*

Phone*

Address*

Eircode

Are you currently linked with a support service or organisation?*

If yes, please provide the name of the Support Service/Organisation

Name of Support Worker/Contact Person

Contact number or email address or service

Please provide the name and contact details of a suitable reference, such as a support worker, employment adviser, community worker or other relevant professional*

Why are you interested in joining the Be Your Own Boss Programme?*

What type of business or self-employment opportunity would you like to explore?

I confirm that the information provided is accurate to the best of my knowledge. I understand that this form registers my interest in the programme and does not guarantee acceptance

Thank you for your interest in the Be Your Own Boss programme.

Please complete this form so we can understand your needs and how best to support you.

Section 1: Personal Details

Section 2: Support Service Involvement

Section 3: Reference Details

Section 4: Your Interest in the Programme

Section 5: Declaration

Contact Us

First Name*

Last Name*

Email*

Phone*

Address*

Eircode

Are you currently linked with a support service or organisation?*

If yes, please provide the name of the Support Service/Organisation

Name of Support Worker/Contact Person

Contact number or email address or service

Please provide the name and contact details of a suitable reference, such as a support worker, employment adviser, community worker or other relevant professional*

Why are you interested in joining the Be Your Own Boss Programme?*

What type of business or self-employment opportunity would you like to explore?

I confirm that the information provided is accurate to the best of my knowledge. I understand that this form registers my interest in the programme and does not guarantee acceptance

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Contact Us

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