CAC COVID-19 Intake Form
The Central Area Collaborative is currently collecting data on the business impacts in the area. We are attempting to learn about what small business owners currently need. Thank you for your participation.
Email address *
Business Name *
Contact Person Name *
Business Address *
Business Position Title *
Business State UBI Number *
Business’s Industry (Restaurant, Driver Service, Retail, etc) *
Are you a Non - Profit or For - Profit Business? *
How many years have you been doing business in the Central Area? *
What’s your Ethnicity?
Number of Full-time Employees *
As a business owner, what tools will help you continue to thrive? *
Estimated Revenue lost due to COVID-19 impacts? Please give a numerical response. *
May you please describe how COVID 19 impacted your business? *
Expenses that currently need coverage *
The Squire Park Community Council prints and distributes a free quarterly newsletter that includes articles written by neighbors. Are you interested in being featured in Squire Park Community Council’s Newsletter?
Clear selection
Any way possible For us to build together! Tell us how you’ll like to be supported during the COVID-19 outbreak and what ways you are supporting folks during the COVID-19 during the outbreak.
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