North Coast Food System Business Questionnaire

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Please help Food Roots get to know you and your business goals by filling out this questionnaire.

Name (first and last): *

Email Address *

Phone Number *

Mailing Address: *

Have you ever participated in an IDA savings program? If yes, which one, and through what organization and state?

If not applicable, please skip to the next question.

How did you learn about this IDA program? Do you know others who, like yourself, may be interested in applying, or qualify for a Food System Small Business IDA? *

Please be specific

My total net assets are equal to or less than $20,000 *

Your primary home, first vehicle, business assets and up to $120,000 in retirement savings are excluded from this calculation

True

False

My total household income meets IDA eligibility (for one person it is $50,850 or less, for two people it is $58,150) *

See the income limits for larger households: www.foodrootsnw.org/ida

True

False

Please give a brief business description; include who you envision as your customer, what you are selling, and any additional info to describe your venture (Is it a start-up, or maybe you are expanding)? *

Do you have other financial investments (bank loans, credit cards, private loans or other resources) currently supporting this business venture? Please explain: *

Please include financial support you are seeking, or currently invested in

What purchases will you be saving for with this IDA, and how will these purchases support your business to start up or expand operations? *

i.e. a tractor, to help till land for increased production; a computer and accounting software to support your bookkeeping; a commercial bread mixer for your bakery

How does (or will) your business support our regional food system on the north coast of Oregon? *

i.e. your fresh, locally grown veggies will be sold at local farmers markets, adding to the diversity and supply of healthy and locally grown foods available to north coast citizens.

Please briefly describe your long term business goal (what do you envision as success for your business?) and please also let us know what gets you excited about this business venture: *

Be specific (i.e. I want to run a fully functioning restaurant that works with local farms to include the tastiest, freshest ingredients in the cuisine offered to my customers. I will be successful because...)

How will reaching this goal benefit you and your family? *

Approximately how much does your household earn per year? *

What changes are you going to make in your money habits in order to be able to save this amount? *

In order to graduate from the IDA program and receive the funding, participants must complete the following requirements: 10+ hours of Financial Literacy curriculum, 6+ hours of Asset Specific Training and write a Business Plan (with support from Food Roots and community partners).What do you hope to get out of this portion of the IDA program? *

Please use the following space if there is any additional information you would like Food Roots to know when evaluating your compatibility, eligibility, and readiness for enrolling in a Food System Small Business IDA (are there additional steps you are taking to prepare for your business venture; relationships; planning; financial preparedness, etc.): *

After you are done filling out this questionnaire and you click "submit," please notify Food Roots that you have submitted your questionnaire by emailing: IDA@foodrootsnw.org. Food Roots' IDA Specialist will get in touch with you to discuss the IDA program in more detail, answer any questions you may have, and talk about the application procedure.

THANK YOU FOR YOUR INTEREST AND THANK YOU FOR SUPPORTING OUR LOCAL FOOD SYSTEM!

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