Business Impact Survey
Thank you for responding to this Rensselaer County Businesses Impact Survey to understand how you and your neighboring businesses are affected by COVID-19. Please provide your contact information if you wish for us to be able to connect with you.
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Business Name
Business Owner Name
Email
Phone Number
Business Location
Business Setting
Clear selection
Business Type
Number of Years In Business
My business is a ______.
Business or Organization Designation
Clear selection
My business is _________ owned.
Clear selection
What industry best describes your business?
How many employees do you have? (For accuracy, please encourage contractors you work with to fill this out as an independent contractor and do not list them as an employee)
Clear selection
The government considers my business ______________.
Clear selection
My physical location is / has __________.
Clear selection
My staff are ___________.
My staffing has __________.
Clear selection
My business can continue to operate for ________ under the current PAUSE conditions.
Clear selection
I am able to sell gift cards in my business.
Clear selection
In order to stay in business, I have _________.
Clear selection
I have applied for the following assistance programs.
I have been approved and/or received funding for the following assistance programs.
If you applied to receive a loan(s), are you concerned about the payback of your loan(s).
Clear selection
What statement best describes the status of your physical location?
Clear selection
What new workforce training will your employees need post-COVID-19?
Clear selection
I would like to speak with someone about my business. (Include Contact Above)
Clear selection
I would like to connect with other businesses in my industry. (Include Contact Above)
Clear selection
Submit
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