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* Your Current Employment Status*Self Employed Full TimeSelf Employed Part TimeEmployed Full TimeEmployed Part TimeDisplace HomemakerUnemployedPublic AssistanceRetiredBusiness InformationWhat 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 businessStarted a business: PLEASE INCLUDE START DATE IN BOX BELOWWhat is the form of the business?*Sole Proprietorship Using Own NameSole Proprietorship Filed DBAPartnershipCorporation - RegularS-CorporationCorporation - LLCBusiness Formation Date* MM slash DD slash YYYY Date of First Sale After Opening MM slash DD slash YYYY This field is hidden when viewing the formDollar Amount of First Sale After OpeningTotal Gross Revenue/Sales Year to DateNumber of Full-Time Employees on First Sale DateNumber of Part-Time Employees on First Sale DateThe Business Facility is*Home BasedOwn Outside FacilityRent Outside FacilityBusiness NameCurrent Business AddressIF HOME BASED BUSINESS USE HOME ADDRESS Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Income Generated by the Business is:*Main Source of IncomeSupplementary IncomeNo Income From BusinessNumber of Business Owners*2024 InformationGross Revenues/Sales $ for 2024*If no sales put $0.002024 Number of Employees Full Time (DO NOT INCLUDE OWNER)*If none put 02024 Number of Employees Part Time (DO NOT INCLUDE OWNER)*If none put 0Total Number of 1099 Contractors in 2023. If none put "0"*2023 InformationGross Revenues/Sales $ for 2023*If no sales put $0.002023 Number of Employees Full Time (DO NOT INCLUDE OWNER)*If none put 02023 Number of Employees Part Time (DO NOT INCLUDE OWNER)*If none put 0Total Number of 1099 Contractors in 2024. If none put "0"*This field is hidden when viewing the form2022 InformationThis field is hidden when viewing the formTotal Number of Full-Time Employees in 2022. If none put "0"*Do Not Include 1099 ContractorsThis field is hidden when viewing the formTotal Number of Part-Time Employees in 2022. If none put "0"*Do Not Include 1099 ContractorsThis field is hidden when viewing the formTotal Number of 1099 Contractors in 2022. If none put "0"*This field is hidden when viewing the formGross Sales Generated by the Business in 2022? If none put "0"*Your NYS Minority/Women Business Enterprise (MWBE) Certification Status. Overview of criteria http://esd.ny.gov/MWBE/Qualifications.html*Have Not AppliedApplication SubmittedApplication in ProcessCertifiedCertification DeniedNot EligibleCertification RevokedRecert Application in ProcessApplication Rejected Funding & ContractsDid You Receive Funding from either: grant, family, friend, investor, crowd funding, bank, credit union, etc since you first started working with WEDC or since you last completed a survey?*YesNoLoan/Grant Information*Date of Loan/GrantFinancial Institution/Funder NameLoan/Grant 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 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.?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.How Would You Rate Your Experience with WEDC?*ExcellentGoodSatisfactoryNeeds ImprovementPoorOptional Additional Feedback About Your ExperienceWEDC Office Nearest You/Are Working With*Please select the WEDC office you have been working with. If you are not sure, choose the one closest to your location.Mid-Hudson PoughkeepsieWestchester - White PlainsNameThis field is for validation purposes and should be left unchanged. Δ
