Report a Success

File
Accepted file types: pdf, jpg, png.
If you prefer to download the form in PDF, complete and sign it rather than submitting the online questionare (below), please attache the form here.
Part I
Name and Contact of Your Company
Company Name:*
Industry*
Contact Name*
First Last
Title:*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax
Email*
Export Experience of Your Firm*
Please indicate your level of export experience
Export Success Details
Company Name:
(Optional)
Industry
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Assistance Provided*
Date of when assistance was provided:
Date Format: MM slash DD slash YYYY
Name of Event or Activity*
1. Outcome Achieved
1. Date of Outcome
Date Format: MM slash DD slash YYYY
Market (Country or Region) of Export Success
Initial Export Sales Resulting from Activity
Projected Export Sales
The amount of sales expected over the next 12 to 18 months resulting from the activity
2. Outcome Achieved
2. Date of Outcome
Date Format: MM slash DD slash YYYY
Initial Export Sales resulting from participation in STEP Activity
3. Outcome Achieved
3. Date of Outcome
Date Format: MM slash DD slash YYYY
3. Outcome Value (USD)
Projected Export Sales
Export sales expected over the next 12 to 18 months
Jobs Impact*
The effect on creating or retaining jobs, in connection with your export activities, and related to participation in the STEP program
Number of Staff hired due to export expansion
Please enter a number from 0 to 100.
Number of employees retained (avoided layoff):
Please enter a number from 0 to 100.
Number of staff you plan to hire as a result of export expansion
Please enter a number from 0 to 100.
Total U.S. Dollar Value of Outcomes:
$0.00
Part II
Client Verification Statement
The California STEP program provided assistance that helped achieve the following outcome(s):
Verification Signature*
- Check box for signature
"I hereby certify that all the information provided in this document, as well as any accompanying documents, are true and complete."
Verification of business or personal information is voluntary. All business or personal information verified will be protected to the extent permitted by the Privacy Act of 1974 and the Freedom of Information Act of 1966. Aggregate data from information verified by companies will be used to report California STEP results to the U.S. Small Business Administration and the public. Please return the signed (check marked) document to California STEP in the cover letter or the eMail address.
Comments
Funded in part through a Grant with the U.S. Small Business Administration.

Part I

Name and Contact of Your Company

Export Success Details

Part II

Client Verification Statement