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 businessRetained/Saved businessStarted a business: PLEASE INCLUDE START DATE IN BOX BELOWBusiness Formation Date MM slash DD slash YYYY The Business Facility is*Home BasedOwn Outside FacilityRent Outside FacilityBusiness Name Current 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 BusinessGross Revenues/Sales $ for most recent FULL Business Year*If no sales put $0.00Number of Business Owners*Number of Employees Full Time (DO NOT INCLUDE OWNER)*If none put 0Number of Employees Part Time (DO NOT INCLUDE OWNER)*If none put 0Your 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 RejectedDid you close your business?YesNoNot ApplicableHidden2020 InformationHiddenTotal Number of Full-Time Employees in 2020. If none put "0"*Do Not Include 1099 ContractorsHiddenTotal Number of Part-Time Employees in 2020. If none put "0"*Do Not Include 1099 ContractorsHiddenTotal Number of 1099 Contractors in 2020. If none put "0"*HiddenGross Sales Generated by the Business in 2020? If none put "0"*Hidden2021 InformationHiddenTotal Number of Full-Time Employees in 2021. If none put "0"*Do Not Include 1099 ContractorsHiddenTotal Number of Part-Time Employees in 2021. If none put "0"*Do Not Include 1099 ContractorsHiddenTotal Number of 1099 Contractors in 2021. If none put "0"*HiddenGross Sales Generated by the Business in 2021? If none put "0"*Hidden2022 InformationHiddenTotal Number of Full-Time Employees in 2022. If none put "0"*Do Not Include 1099 ContractorsHiddenTotal Number of Part-Time Employees in 2022. If none put "0"*Do Not Include 1099 ContractorsHiddenTotal Number of 1099 Contractors in 2022. If none put "0"*HiddenGross Sales Generated by the Business in 2022? If none put "0"*HiddenAre your employees on...?What is the mix of your workforce?1099W2A mix of both 1099 and W-2NeitherHiddenWhen did you close your business? MM slash DD slash YYYY HiddenWhy 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 FeedbackHiddenWhat other services did WEDC provide that helped your business during the recoveryWhat 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.?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 PlainsCommentsThis field is for validation purposes and should be left unchanged. Δ
