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BUSINESS PLAN C O M P E T I T I O N

T H E N A T I O N ’ S P R E M I E R Summer Entrepreneurial

Academic Enrichment C A M P P R O G R A M

ELIGIBILITY: open to all students 6th – 8th grade. Students residing outside of Trenton, New Jersey will be responsible for their daily transportation to

and from Rider University. Hours of camp operation is Monday through Friday 8 a.m. to 4 p.m.

Minding Our Business, Inc.Program in Entrepreneurship

MINDING OUR BUSINESSBRIDGE TO THE FUTURE

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KEVIN W. WORTHAMCo-Founder & Executive Director

609-731-9311Fax: 609-896-5304

email: [email protected]

SIGFREDO A. HERNANDEZ, ph.d.founder

609-895-5509Cell: 267-879-9029


C/O Rider University • Minding Our Business • 2083 Lawrenceville Road • Lawrenceville, NJ 08648-3099 • www.minding-our-business.com


Summer Entrepreneurial Program Application

June 28th to August 15th, 2015


Please print all information clearly (blue or black pen only)

Male_______ Female _______Date of Birth_______

Ethnicity (optional)African American__ Asian__Caucasian__Latino__Native American__Other__

Student’s Name: _____________________________________

Current Grade Level: _______

Student Email Address (opitional):______________________

Home Phone (including Area Code): _________________________ Home Mailing Address (including Zip Code): _________________________________________________________________________________

Have you ever participated in this program? Yes______ No_______ If so, which year?_______

Do you know of another student who has participated in the program? If so, please list their name_____________________________

Please list other activities, groups and or teams that you are involved with (this may include church activities) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please complete the application in its entirely. An incomplete application will not be accepted.

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School and Parent/Guardian Information

Principal’s Name: _____________________________________

School Name: _________________________________________

School Address: _____________________________________________________________________

School Main Phone Number (including Area Code)_________________________

Parent/Guardian Name: _____________________________________

Relation to the student: _____________________________________

Work Phone (including Area Code):_________________________

Cell Phone (including Area Code): _________________________

Home Phone (including Area Code): _________________________

Email Address: _________________________

1. Emergency Contact Name: _____________________________________

Relationship to student: _____________________________________ Emergency Contact Number: _________________________

2. Emergency Contact Name: _____________________________________

Relationship to Student: _____________________________________

Emergency Contact Number: _________________________


609-731-9311Fax: 609-896-5304



609-895-5509Cell: 267-879-9029







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609-731-9311Fax: 609-896-5304



609-895-5509Cell: 267-879-9029







Will your child need to take any prescription medications while at camp? Yes / No If yes, please provide doctors’ note – and dispensing instructions for your child form.

ALL medication should be in a ziplock bag with your child’s name on it.

Allergies: (Please put N/A if your child does not have an allergy)

Food_____Medication______Insect______Other_______

Does your child require an Epi-pen? ______________ If yes, you must provide the camp with an Epi-pen to be kept at camp during your child’s enrollment. Epi-pen must be accompanied with a current prescription and a doctor’s note.

If your child is currently taking medications please list them:

Specific Activities to be restricted for health reasons:

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609-731-9311Fax: 609-896-5304



609-895-5509Cell: 267-879-9029







PLEASE RESPOND AS BEST AS YOU CAN TO THE FOLLOWING ESSAY QUESTIONS.(You may type the answers and questions on a separate sheet of paper)

1. Why would you like to participate in the Minding Our Business (M.O.B.) Summer Entrepreneurial Program?

2. Please describe a hobby or interest that you might like to develop into a business opportunity. If you already have a business or a business idea, please explain. Supporting documents may be attached.

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609-731-9311Fax: 609-896-5304



609-895-5509Cell: 267-879-9029







3. At Minding Our Business asking good questions is as important as answering. Now, we would like you to do both. Ask and answer a question that reveals something interesting about you; a humorous anecdote, significant academic encounter/challenge or test of character.

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609-731-9311Fax: 609-896-5304



609-895-5509Cell: 267-879-9029







Recommendation Form by Math Teacher(Must Be Returned With Completed Application)

(Please PRINT clearly)

Name of Applicant: __________________________

Name of Individual Providing Recommendation: _______________________________________________

Title: _________________________________ Daytime Phone #: ( ) ___________________________

School/Organization: _________________________________________________________________

How long have you known the applicant: _____________________

Please rate the applicant in the following areas to the best of your ability based on the following scale:

1 - strongly disagree 2 - disagree 3 - agree 4 - strongly agree

1. Demonstrates to be academically strong 1 2 3 4 N/A

2. Completes homework on time 1 2 3 4 N/A

3. Demonstrates motivation to learn 1 2 3 4 N/A

4. Shows to be well-behaved 1 2 3 4 N/A

5. Is proficient doing computations with decimals 1 2 3 4 N/A

1. Overall impression of the applicant____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Does the applicant have a learning disability? ____ yes _____ no If yes, explain ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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609-731-9311Fax: 609-896-5304



609-895-5509Cell: 267-879-9029







Recommendation Form by Teacher(Must Be Returned With Completed Application)

(Please PRINT clearly)

Name of Applicant: ___________________________________________________________________

Name of Individual Providing Recommendation: _______________________________________________

Title: _________________________________ Daytime Phone #: ( ) ___________________________

School/Organization: _________________________________________________________________

How long have you known the applicant: _____________________

Please rate the applicant in the following areas to the best of your ability based on the following scale:

1 - strongly disagree 2 - disagree 3 - agree 4 - strongly agree

1. Demonstrates to be academically strong 1 2 3 4 N/A

2. Completes homework on time 1 2 3 4 N/A

3. Demonstrates motivation to learn 1 2 3 4 N/A

4. Shows to be well-behaved 1 2 3 4 N/A

1. Does the applicant have a learning disability? ____ yes _____ no If yes, explain _______________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Is the student working on, above or below grade level? 3. If below, please indicate the grade level the student is working where they are meeting success. ___________ 4. Does this student have an Individualized Educational Plan or 504 Modification Plan? Yes or No

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609-731-9311Fax: 609-896-5304



609-895-5509Cell: 267-879-9029







5. If yes, please list the classification or pertinent information that would help us to understand the students needs.________

6. Overall impression of the applicant _______________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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609-731-9311Fax: 609-896-5304



609-895-5509Cell: 267-879-9029







StudentI understand that as a participant in the Minding Our Business Summer Program I must:

• Make a commitment to attend the entrepreneurship training at Rider University from June 25th to August 17th, 2014 (transportation from Trenton and snacks and lunch will be provided by the program).

• Attend the Orientation Session at Rider University on Sunday June 22nd from 3 -5 p.m. (buffet dinner and transportation from Trenton will be provided by the program).

• Attend all 4 Summer Market Fairs.

• Attend all 3 evening Business Coaching Sessions: at the Big Easy Restaurant, at Colonial Lanes, and at Rider University.

• Observe the program ground rules for responsible behavior.

I understand if I meet the above requirements, I would be allowed to participate in the following activities:

• 2 Field Trips to New York City’s Wholesale District

• 2 Field Trips to the Columbus Farmers Market.

• A Fun Field Trip to Dorney Park.

• A Fun Field Trip to Clementon Park

• 2 Bowling Nights at Colonial Lanes.

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609-731-9311Fax: 609-896-5304



609-895-5509Cell: 267-879-9029







Parent/Guardian General Permission• I understand that if my child is accepted in the program the cost to me is based on a sliding income scale.

• I authorize my child to participate in the Minding Our Business Summer Program and all activities specific above including the training at Rider University, 4 Market Fair events, and the field trips and outings specified above.

• I authorize my child to participate in the 3 evening Business Coaching Sessions.

• I will attend the Orientation Session at Rider University (food and transportation will be provided)

• I authorize Minding Our Business to: 1. utilize pictures or videos of my child, in connection with this program, for publication by newspapers or other mass media; and 2. allow the director of this program access to the future academic records of my child in order to determine the impact of this program on his/her academic development.

• In the case of an emergency, I hereby give permission for the hospital/doctor to provide care/treatment for my child until I can reach the hospital.

• I understand Minding Our Business’s discipline policy and understand I am responsible for my child’s actions while involved in Minding Our Business activities. I also understand that if my child breaks Minding Our Business policy my child may be expelled from the program without reimbursement of fees paid.

• I understand that there are inherent risks associated with participating in Minding Our Business activities and I do not hold the Minding Our Business directors or staff responsible for injuries, resulting from Minding Our Business participation. My signature below indicates my acceptance of the policies above.

For more information call Dr. Hernandez at 267-879-9029 and/or Mr. Kevin Wortham at 609-731-9311.

________________________________ _______________ Signature of Parent or Guardian Date

________________________________ _______________ Signature of Student Date

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609-731-9311Fax: 609-896-5304



609-895-5509Cell: 267-879-9029







Scholarship Availability FormThe cost of the Minding Our Business Summer Program is $2,500.00. It is expected that families contribute to the cost of the program. If your child is accepted into the program your fee will based upon your total household or family income level -please see the below pay scale for your rate. You may pay by Cash, Check, Money Order or Credit/Debit Card or installments or payment plan. All fees must be paid prior to the start of the program.

Pay Scale:

r $ 0-30,000 your fee will be $400.00

r $30,001-$40,000 your fee will be $550.00

r $40,001-$50,000 your fee will be $700.00

r $50,001-$60,000 your fee will be $850.00

r $60,001- $79,999 your fee will be $1,000.00

r $80,000 and up your full-tuition fee will be $2,500.00

Please provide a copy of your recent pay stub or tax return-this financial documentation is needed to insure eligibility and will be held in confidence.

Number of people living in the household______________________

Amount you will be pay based upon the pay scale $_________________________

Parent Signature and date: ________________________________________________________ i certify that the above information is correct

Credit/Debit Card

Card Type ___________________Card Number ___________________________ Exp. Date _______

Auto-draft – By signing below, you are giving us permission to charge the card identified above each Monday a balance is due and payments arrangements have been made Initial ______

Signature ___________________________________________ Date ___________

You can either mail the form back to: C/O Rider University, Minding Our Business, 2083 Lawrenceville Road, Lawrenceville, NJ 08648-3099 OR you may deliver to: Swiegart Hall, College of Business, Rm 357 on or before May 13, 2015.

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