Small Business Event Survey Your responses to this form will be kept confidential. Contact Information First Name Last Name Email Phone City Workshop information What workshop did you attend?Please select... May Small Business Fundamentals June Small Business Fundamentals Please rate this workshop from 1-5 (1- not helpful, 5- very helpful)12345 What did you enjoy about the workshop? What needed improvement? What other workshops would be helpful to you? What time of day works best for you to attend future workshops?MorningAfternoonLate afternoonEvening Are you interested in 1:1 business counseling with us?YesNoUnsureNot at this time, but possibly in the futureI am already a client receiving 1:1 Counseling in the Small Business Program. Contact & Demographic Information Home Address Home City Home State Home Zip Code Business Information (If you do not have official business information, enter your personal information.) Business Name If you do not have a business name, please leave this field blank. Business Address Business City Business State Business Zip Code Business Phone Number Business Email Other Owners of the Business Is there another person who owns this business besides yourself?YesNo Name(s) of additional business owner(s): Email address(es) of additional business owner(s): What type of small business do you own? For example: restaurant, pet groomer, acupuncture What stage of Business are you in?Prospective Business Owner (about 1 year from starting a business)Pre-Startup (within one year of startup)Startup (business operating/generating revenue less than 1 year)Established Business Clients (in business more than 1 year and generating income) What business setup do you have?Please select... Business has brick-and-mortar location Home-based business Business has another arrangement Are you working with any other small business consultants? If so, who? What are the top 3 business goals that our Valley Community Development Small Business Consultants could help you with? Combined Household gross annual income: Your gross annual income is required data needed to fund our Valley Community Development Small Business Program. Your data is only shared for reporting purposes and we prioritize our clients' confidentiality. How many people live in your household? GenderMFOtherChoose not to respond Do you identify as LGBTQ+?YesNoChose not to respond Do you identify as disabled?YesNo Are you a veteran?YesNo Select the race(s) with which you most closely identifyArabAfrican AmericanAsianBlack/CaribbeanLatino/LatinxNative AmericanNative Hawaiian or Pacific IslanderWhiteMultiracialOtherChose not to respond In addition to the above, do you consider yourself Hispanic?HispanicNon-HispanicChose not to respond Do you identify as an immigrant or non-native English speaker?Yes, an immigrantYes, a non-native English speakerNo Do you consider yourself a minority? YesNo By checking this box and typing my name below, I certify that the information contained herein is true, complete, and correct to the best of my knowledge and belief. I affirm that I own or am associated with the business or prospective business receiving technical assistance. Ok Name Date Which mailing lists would you like to subscribe to? Monthly Newsletter Homeownership Program Information Small Business Assistance Information Affordable Housing News How did you hear about us? Please select... Word of Mouth Website Facebook Twitter Instagram LinkedIn Flyer Other Other Formula field reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. Contact Us
