UMEA InTake Survey
Thank you in advance for taking just a few minutes to fill out this survey. Your responses will remain confidential, and compilation results will be used for the purposes of soliciting funding, improving customer service to our members, and assessing how UMEA can add value to minority entrepreneurs in the Central New York region. Please allow ample time for your form to be received and reviewed before the establishment of an appointment. PLEASE BE SURE TO CLICK ON "SUBMIT" AT THE CONCLUSION OF THIS SURVEY IN ORDER FOR YOUR RESPONSE TO BE COUNTED.
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Email *
Name *
Name of Business *
Title *
Email address *
Phone Number 1: Business or Cell Phone *
Phone Number 2: Business or Cell Phone
Business Mailing Address *
Business/Mailing Address: City, State, Zip Code *
Online presence: Your Website, facebook, etc. *
Gender *
Race/Ethnicity *
Age (optional)
What is your membership status? *
How did you find out about UMEA? *
Please explain "Other"
Please connect me with (I opt-in and grant UMEA permission to share my information with these partners): *
Business Formation *
How long have you been in business? *
Please indicate month and year
Are you celebrating any special occasions in the near future? If so, what? (e.g., ribbon-cutting, groundbreaking, expansion, etc.)
Regardless of how long I've been in business, I would characterize my business as: *
Do you have any employees? *
If yes, how many (including yourself)?
Do you have Independent Contractors? *
If yes, how many?
What was your 2019 Gross Revenues? (optional)
What professional or trade certifications do you possess?
Are you M/WBE Certified? *
Have you ever acquired any contracts? *
If you are not M/WBE Certified, do you plan to do so--is it your goal to become certified by the City or State? *
Is your business product-based, service-based or both? *
Describe your goods and/or services *
What type of Entrepreneur or Business Owner best describes you? *
Is your business brick-and-mortar, home-based or Internet-based? (check all that apply) *
Are you in the construction trade industry? *
If the answer is "Yes" to the above, then what is your status?
Clear selection
Have you done/do you regularly do business with other minority business entrepreneurs? (Whether or not they are UMEA members.) *
If so, how much was the purchase of goods or services worth? (No need to name the business)
Column 1
$1 - $50
$50 - $100
$100 - $250
$250 - $500
$500 - $750
$750 - $1,000
Clear selection
Do non-minorities support YOUR business enterprise? *
What type of training or technical assistance would you like to take advantage of? *
Did the COVID-19 Pandemic affect you and your business? *
How so? Please explain or elaborate on the previous question.
Did you apply for any type of assistance during the COVID-19 pandemic? *
Please check all programs that you applied for *
Did you receive assistance during the pandemic? *
What kind of training or technical assistance would you like to see UMEA provide in 2021? *
How can UMEA add value to you and your business? *
Are you receiving UMEA's MailChimp notifications? *
Are you receiving UMEA's EventBrite notifications? *
Are you liking UMEA on social media (i.e., Facebook or Twitter)? *
Would you feel comfortable recommending UMEA to a friend? *
Why or Why Not?
Is there any additional information you wish to share where UMEA can add value to your business and enhance your experience?
A copy of your responses will be emailed to the address you provided.
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