14th District of Illinois: Small Business COVID-19 Relief Programs Survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

The purpose of this survey is for businesses in the 14th District of Illinois to provide feedback to Congresswoman Underwood about their experience with COVID-19 federal relief programs, how federal relief programs have benefitted local small business community, and what assistance they continue to need going forward.

Prefix

First Name *

Last Name *

Best Phone Number to reach you *

Best Email to reach you *

Your Business Name *

What type of business is this? *

Are you the business owner? If not, what is your role at the business? *

Your Business Address *

City *

Postal Code *

Your businesses social media handles (Facebook, Twitter, Instagram):

Your Personal Address

Demographic Information- Is your business: *

Women Owned Business

Minority Owned Business

Veteran Owned Business

LGBTQI+ Owned Business

None of the above

Required

What, if any, federal funding did you apply for and receive during the course of the COVID-19 pandemic? *

Paycheck Protection Program

Economic Injury Disaster Loan

Shuttered Venue Operators Grant

IL BIG Grant

Restaurant Revitalization Fund Grant

Local Government Grant

None

If you received any funding, please list the amount of funding for each program below. *

Please share any stories or notes you may have on the funding you received or did not receive that you would like to share with the Congresswoman. For Example: How the funding helped you during this time, how you were able to use the funding, how your community responded to the pandemic.

Did you benefit from any additional state or local funding during the course of the COVID-19 pandemic not listed above? If so, please list the program and the amount received

Did the funding you received meet your needs? If you did not receive funding please share why you may not have applied or why you may not have qualified.

How can Congresswoman Underwood and Congress best serve your business and the business community moving forward?

Would you be amenable to a conversation or site visit with Congresswoman Lauren Underwood to discuss about your experience during COVID-19 and federal relief programs? *

Yes

Maybe

Please share any additional notes, comments, or concerns you may have with the Congresswoman.

Thank you for sharing this information about your business. If you have follow up questions, please call Ashley Clayton at 202-868-0103

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms