Form SBA Form 2453 SBA Form 2453 SBA Form Boots to Business Course Registration

U.S. Small Business Administration
Boots to Business Course Registration

OMB Control No: 3245-0384
Expiration Date:05/31/2018

Use of information: This information collection (form) is to be completed by individuals seeking to participate in
the Boots to Business (B2B) courses offered by the Small Business Administration (SBA) as part of the Transition
Assistance Program (Transition GPS). Disclosure of the information requested on this form is voluntary; however,
if you fail to provide the information we will not be able to register you for the Boots to Business courses and you
may not be able to participate in the training. The information is collected to help SBA’s continuing improvement
and oversight of business counseling services offered to participants in the Agency’s B2B Program. All
information provided is protected to the extent permitted by law, including the Privacy Act of 1974, 5 U.S.C. 552a
and the Freedom of Information Act (FOIA), 5 U.S.C. 552. SBA maintains your personal information in the
agency’s Privacy Act Systems of Records, SBA 5-- Business and Community Initiatives Resource Files. This
system of record notice (SORN) identifies why and to whom SBA will routinely disclose the information that you
provide.
In addition to those routine uses, please select yes or no below to indicate whether you authorize SBA or its
agent to also use your name and contact information for SBA surveys and information mailings regarding SBA’s
B2B offerings or other products and services available to veterans. SBA will not provide your personal
information to commercial entities. Choose an item.
Please note: Under the Paperwork Reduction Act you are not required to respond to any collection of information
unless it displays a currently valid OMB Control number. This collection has been assigned OMB Control number
3245-0384. The estimated time for completing this form is 5 minutes, including gathering and submitting the
information. Comments on the estimated time, including suggestions for reducing the time, should be sent to: U.S.
Small Business Administration, 409 3rd Street, SW, Washington, DC 20416, and to: SBA Desk Officer, Office of
Management and Budget, New Executive Office Building, Room 10202, Washington, D.C., 20503.
1. Please select the course for which you are registering: Choose an item.
2. Enter the dates of the Boots to Business course for which you are registering: Click here to enter a date.
3. Enter the name of the installation/location of the training for which you are registering. Click here to enter text.
4. Name: Click here to enter text.
5. Phone number: Click here to enter text.
7. Service: Choose an item.
9. Please select your service component:

Choose an item.
11. Are you receiving or did you receive an
honorable discharge? Choose an item.
13. Gender: Choose an item.
15. Race (please select one or more):
☐American Indian ☐Alaska Native ☐Asian
☐Black or African American
☐Native Hawaiian or Other Pacific Islander
☐White
☐Not Stated
17. Years of Service: Click here to enter text.

SBA Form 2453 (05-15)

6. Personal Email address: Click here to enter text.
8. Please select your pay grade and status, if applicable:

Choose an item.
☐Dependent Spouse ☐Dual Military Spouse
☐Other Dependent
10. What is your military job title
(MOS/AFSC/Designator/Rating)? Click here to enter text.
12. Age Range: Choose an item.
14. Ethnicity: Choose an item.

16. Please select your transition type: Choose an item.

18. Which of the following best describes your current status:
Choose an item. ☐ Other: Click here to enter text.