Client Survey Please fill out the form below so we can continue to provide you with quality services and programming. We look forward to hearing how you are doing and your feedback. Step 1 of 4 25% Name* First Last Phone*Email* Company Name Current Business AddressIf a home based business use home address. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Your Current Employment Status*Self Employed Full TimeSelf Employed Part TimeEmployed Full TimeEmployed Part TimeDisplace HomemakerUnemployedPublic AssistanceRetiredWhat is the current status of your business?*No longer interested in starting a businessIn Process of Starting or Acquiring a BusinessDecline in existing businessNo change in existing businessRetained/Saved businessStarted a business: PLEASE INCLUDE START DATE IN BOX BELOWDate business was formed MM slash DD slash YYYY The Business Facility is*Home BasedOwn Outside FacilityRent Outside FacilityIncome Generated by the Business is:*Main Source of IncomeSupplementary IncomeNo Income From BusinessNumber of Business Owners*Your NYS Minority/Women Business Enterprise (MWBE) Certification Status. Overview of criteria http://esd.ny.gov/MWBE/Qualifications.htmlHave Not AppliedApplication SubmittedApplication in ProcessCertifiedCertification DeniedNot EligibleCertification RevokedRecert Application in ProcessApplication Rejected2020 InformationTotal Number of Full-Time Employees in 2020. If none put "0"*Do Not Include 1099 ContractorsTotal Number of Part-Time Employees in 2020. If none put "0"*Do Not Include 1099 ContractorsTotal Number of 1099 Contractors in 2020. If none put "0"*Gross Sales Generated by the Business in 2020? If none put "0"*2021 InformationTotal Number of Full-Time Employees in 2021. If none put "0"*Do Not Include 1099 ContractorsTotal Number of Part-Time Employees in 2021. If none put "0"*Do Not Include 1099 ContractorsTotal Number of 1099 Contractors in 2021. If none put "0"*Gross Sales Generated by the Business in 2021? If none put "0"*2022 InformationTotal Number of Full-Time Employees in 2022. If none put "0"*Do Not Include 1099 ContractorsTotal Number of Part-Time Employees in 2022. If none put "0"*Do Not Include 1099 ContractorsTotal Number of 1099 Contractors in 2022. If none put "0"*Gross Sales Generated by the Business in 2022? If none put "0"*Are your employees on...?*What is the mix of your workforce?1099W2A mix of both 1099 and W-2NeitherIs Your Business Still Open?*YesNoNot ApplicableWhen did you close your business? MM slash DD slash YYYY Why Did You Close Your Business?BankruptcyInsufficient sales or customer interestProblems with business strategyPreferred a wage jobIllness or heath reasons of business ownerNeeded to take care of family member/ other household concernsMovedDon't know Funding & ContractsDid You Receive Funding from either: family, friend, investor, crowd funding, bank, credit union, etc since you first started working with WEDC or since you last completed a survey?*YesNoLoan Information*Date of LoanFinancial Institution/Funder NameLoan AmountPurpose/Use of Funding Was the funding an SBA loan?*YesNoDid you receive a government contract in the last 3 months?*YesNoContract Information*DateAgency or AuthorityAmount FeedbackWhat other services did WEDC provide that helped your business during the recovery*What are the top challenges you are facing right now. Such as: Determining Target Market, Acquiring customers, Sufficient Cash Flow, Understanding Financial Statements, Can't Find Employees, Need Financing, etc.What subjects would you like to learn more about? Also please give us a brief update on your business. Have you pitched an idea to a potential client, developed a new product, received any awards, etc.?WEDC Office closest to your location*Please select the WEDC office closest to your location.Mid-Hudson PoughkeepsieWestchester - White PlainsHow Would You Rate Your Experience with WEDC?*ExcellentGoodSatisfactoryNeeds ImprovementPoorOptional Additional Feedback About Your ExperienceCommentsThis field is for validation purposes and should be left unchanged. Δ
