Rapid Assessment Form
The New York Women's Chamber of Commerce is able to provide free services to you thanks to the funding we get from government and private entities. In order to keep this funding, we need to collect information, including demographics, from those whom we serve. If you have not done so already, please take a minute to fill out and submit this form to us. It will help us continue providing our services. Thank you!
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Today's Date
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2. First Name *
3. Last Name *
4. Business Name (DBA) *
4a. Business Phone *
4b. Business Email *
4c. Business Address *
5. City
6. State
7. Zip code *
8. Preferred Language
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9. Were you born outside the US?
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10. If yes, what is your country of birth?
11. Is your business...
12. Is your business certified as MWBE?
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13. EIN #
14. Date when business began operations
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15. Where do you sell your products/services? *
Required
16. Business' Legal Structure
17. Industry *
Required
18. Number of Full-Time Employees--Not counting the owner(s)
19. Number of Part-Time Employees
20. # Owners
21. Is your business part of a franchise or chain?
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22. Previous Year's Business Revenue
23. What services are you interested in? *
Required
24. How has COVID-19 impacted your business?
25. What is your biggest challenge as a business owner?
26. Do you have access to information from SBS and other City agencies about support for storefront businesses?
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Finally, just a few questions about yourself and your household, which will help us with demographic information.                                                                                                                                                                       27. How many people live in your household?                                                                          
28. What is your marital status?
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29. What is the income for your household (total for all members of the household)?
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30. What is your gender?
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31. What is your race/ethnicity?
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32. Year of birth
33. Highest education credential
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33. NYWCC Staff member name (if applicable)
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