JAN on Demand (Self-Employment)

If provided, your name, phone number, mailing address and email will be kept confidential and stored in a secure database that is not shared with anyone. If you do not want this information to be stored, please do not provide it. You may choose to remain anonymous.

First Name

Last Name

Your Email Address*

Please double check your email address. Note that you need to make sure your email account will accept @jan.wvu.edu and @askjan.org email addresses. Your spam filter should be set so that JAN replies can be received to your inbox.

Your Phone Number

Please double check your telephone number with area code.

This Phone Number is

Work

Home

Cell

State, Territory or Location

Contacting JAN as

If your question concerns a self employment question, please complete as many of the following items as applicable OR go to the bottom of the form to submit a question.

1. Are you an individual with a disability or limitation? If applicable, what is the specific disability or medical condition?

2. Do you have a particular business idea in mind?

3. Where are you currently in the process of getting started?

4. Are you working with any local employment programs for people with disabilities, such as vocational rehabilitation?

5. Have you contacted or worked with any programs that help with small business development (e.g., SBA, SBDC, SCORE, etc.)?

6. Are you currently receiving any income support (e.g., SSI, SSDI, veteran's benefits, private disability, unemployment, etc.)?

7. What are the main issues we can assist you with?

8. Will you need any alternative formats?

Please also include your mailing address (street address or P.O. Box, city, state, and county)

Note: JAN can provide technical assistance, but JAN is not a legal service so cannot provide legal advice. If you need legal advice, you should consult a legal service.

Would you like to subscribe to JAN's quarterly newsletter?

Yes

Send Email Confirmation

Check this box to send a confirmation email to the Email Address entered above.