MHV Client Survey Step 1 of 4 25% Name* First Last Phone*Company Name 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 Income Generated by the Business is:*Main Source of IncomeSupplementary IncomeNo Income From BusinessNumber of Business Owners*Total 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 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 ContractorsThe Business Facility is*Home BasedOwn Outside FacilityRent Outside FacilityGross Sales Generated by the Business in 2020? If none put "0"*Gross Sales Generated by the Business in 2021? If none put "0"*Is Your Business Still Open?*YesNoWhen 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 Did 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 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 RejectedWhat are the top challenges you are facing right now. Such as: Determining Target Market, Aquiring 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 ExperiencePhoneThis field is for validation purposes and should be left unchanged. Δ
