APPLY FOR A WEDLI'S DOROTHY TRIPP/ SALLY
SLACKE AWARD
Directions:
Print out application and complete all questions.
Mail with any supporting documents to:
Roslyn Goldmacher, Esq.
President & CEO
Long Island Development Corp.
45 Seaman Avenue
Bethpage, NY 11714
Name of
Applicant:
Home Address:
City:
State:
Zip:
Home Phone:
Email:
Applicant's Business Name:
Business
Address:
City:
State:
Zip:
Bus. Phone:
Bus. Fax:
Bus. Email:
Recommended by:
Use
of award proposed:
enrolled in or graduated from Suffolk Community College Entrepreneurship
Program (funds may be used for tuition or business)
For Female Entrepreneur:
What percentage of business do you own?
How long in business:
Type of business:
Brief description of business:
For economic developer:
Describe your position in economic development:
For both: Describe how this award will help you:
If existing business, 3 years financial statements
or federal tax returns (profit & loss; balance sheet);
If start up, opening balance sheet and projected profit
& loss 2 years;
For both: what was your personal gross income last
year?_________ How much do you personally have in liquid
assets (savings accounts, checking, cd's,money markets,
stock accounts)?_________
Note: these awards are to help deserving entrepreneurs
and economic developers who need assistance to accomplish
their dreams.
Signature:_____________________________
Print Name:____________________________
Signed by applicant______ or nominator_____
Print out and mail completed application to:
WEDLI Award Committee
Women Economic Developers of LI
Roslyn Goldmacher, Esq.
President & CEO
Long Island Development Corp.
45 Seaman Avenue
Bethpage, NY 11714
NOTE: APPLICATIONS NOT ACCOMPANIED BY THE APPROPRIATE
ATTACHMENTS, NUMBERS II THROUGH IV ABOVE, WILL BE CONSIDERED
INCOMPLETE AND WILL NOT BE CONSIDERED FOR AWARDS.
