HCPA Caribiz Feature Intake Form

Please complete this Caribiz screening form if you’re interested in being an HCPA Caribbean community feature.

Full Name *

Business Name *

Business Address *

Email *

Phone number *

Website (if applicable)

Please provide your social media accounts (if applicable)

In a few sentences, describe your business. What products or services do you offer? *

Please share your Caribbean heritage and the specific country or island *

How long have you been in business?

Have you been actively involved in the Caribbean or local community in Houston? *

What are some of the unique challenges you've faced as a business owner of Caribbean descent in Houston? *

Share a significant achievement or success story related to your business that you're particularly proud of *

If selected for our marketing feature, are you willing to be interviewed and provide high-quality images of your business for promotional purposes? *

Consent and Release: *

By submitting this questionnaire, I grant permission for my business and personal information to be used in your marketing campaign, including interviews, photos, and any related promotional materials.

Please type your full name to signify your agreement with the above statement. *