2021 Impact Survey 2021 Impact Survey Hi, this is [your name] calling from Women’s Economic Development Center. How are you? Respond accordingly. I’m calling to check in, see how things are going and gather some information. Your feedback is very important to WEDC. In addition to helping us enhance our services to meet our clients’ needs, we are able to demonstrate to our funders how their funding supports small businesses. I have a few questions that should only take 10-15 minutes of your time. We can either talk now, or set up a time to talk later. Which would you prefer? LATER> set up a later date NOW>continue. Great, thanks! Some of the questions I’ll be asking are the same as those you answered when you first came to WEDC. By collecting this follow-up data, we’re able to measure changes from intake to now, and get a sense of our impact. Before we start, I just want to let you know that the information you share with me will kept confidential and aggregated, so you don’t have to worry about your privacy.client ID# Name(Required) First Last Why you originally came to WEDC for assistance.(Required)Tell us about your experience.(Required)What would you change about your experience if you could?(Required)Did you operate a business at any time from January 1 – December 31, 2020?(Required) Yes No A business an establishment that has made sales and is actively pursuing new customers. Self-employment qualifies as being in business as long as the client was paid for a product or service (made sales), and they have more than one client (e.g. an Uber Driver is not “in business” since they are paid by Uber as an independent contractor).Have you ever owned a business?(Required) Yes No What is the primary reason you haven’t started a business?(Required) Not enough capital Too much of a time commitment Realized business idea wasn't feasible Need more experience in industry Personal/ family issues (income, health, etc.) Preferred a wage job Other When did you start your business?(Required) MM slash DD slash YYYY What is the main reason you started your business?(Required) Lack of advancement opportunities in your job Unable to find a job To supplement your household income To work for yourself, not others Flexibility Don't know Other Is your business still open?(Required) Yes No When did you close your business?(Required) MM slash DD slash YYYY Why did you close your business?(Required) Bankruptcy Insufficient sales or customer interest Problems with business strategy Preferred a wage job Illness or heath reasons of business owner Needed to take care of family member/ other household concerns Moved Don't know Other Did you operate your business full-time, part-time, or seasonally?(Required) Full time Part time Seasonally Full time is 35 hrs per week or more.Briefly describe your business:(Required)Does your business have a DUNS #? Yes No What is the number? Do you know the NAICS code for your business? Yes No What is it? How has COVID-19 affected your business? (select all that apply)(Required) Closed business permanently Closed business temporarily Reduced hours Lost sales Laid off employees No effect Other Please describe(Required) What is the greatest need/challenge facing your business at the moment? (select all that apply)(Required) Lack of funding Slow sales Problem with business model Management/ operations issues None Other Please describe(Required) What WEDC services would be most helpful to you or your business right now? (select all that apply)(Required) Business loan Financial consulting/ training Business mentoring Business training Business counseling Other Please describe(Required) Business Name(Required) Business PhoneBusiness Email Business Website What is the legal structure of your business? Corporation LLC Partnership S-Corporation Sole proprietorship Other Not established yet Don't know What were your total gross business sales (before expenses) last year?If the client seems unsure, offer to follow up with them at a later time after they have had the chance to review their tax return. Legal Structure Tax Form, Line Sole Proprietorship Schedule C, Line 1 Partnership Form 1065, Line 1c S Corporation Form 1120S, Line 1c C Corporation Form 1120, Line 1c LLC – individual owner Schedule C, Line 31 (business), Schedule E, Line 25 (rental/royalties), Schedule F, Line 9(farm) LLC – multiple members Form 1065, Line 1cApproximately what % of your business income did you use for personal or household expenses last year? What was your net profit/loss (sales minus expenses) from your business last year? Enter losses as a negative number. If the client seems unsure, offer to follow up with them at a later time after they have had the chance to review their tax return. Legal Structure Tax Form, Line Sole Proprietorship Schedule C, Line 31 Partnership Form 1065, Line 22 S Corporation Form 1120S, Line 21 C Corporation Form 1120, Line 28 LLC –individual owner Schedule C, Line 1 (business), Schedule E, Line 24 (rental/royalties), Schedule F, Line 34 (farm) LLC – multiple members Form 1065, Line 22Besides yourself, how many paid full-time employees did your business have last year? Besides yourself, how many paid part-time employees did your business have last year? Did your business receive any of the following resources last year?(Required) Bank Loan (SBA Lender) Bank Loan (Non-SBA Lender) Non-Bank Online lender (Square, Kabbage, On Deck) Outside Investment (friends/family/crowd funding) Credit Card Owner Investment (cash, equipment, etc.) SBA Disaster Loan/Advance SBA PPP Loan NYS Forward Loan None Other Please describe:(Required) Bank Loan (SBA Lender) amount receivedBank Loan (Non-SBA Lender) amount receivedNon-Bank Online lender (Square, Kabbage, On Deck)Outside Investment (friends/family/crowd funding) amount receivedCredit Card amount receivedOwner Investment (cash, equipment, etc.) amount receivedSBA Disaster Loan/Advance amount receivedSBA PPP Loan amount receivedNYS Forward Loan amount receivedOther amount receivedDid you work for someone else last year? Yes No Was this job full time, part time, or seasonal? Full time Part time Seasonal Full time is at least 35 hours per week.What were your pre-tax wages from this job last year?What are your plans going forward for your business and for working outside of your business?Counting yourself, your spouse or partner, and including children, how many people lived with you and shared income or expenses last year? What was your total household income last year?Line 6 on form 1040Do you have any questions or comments that you would like to add?Thank you again for taking the time to speak with me. Once again, your feeback is very valuable to WEDC. Please let us know if there’s anything we can do to support you in the future.Interview SectionInterviewer Name Date of Interview MM slash DD slash YYYY Potential Client Profile? Yes No Comments Δ
