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The Risk & Mitigation of Cyber Threats in Remote Customer Service or Telework practices 07/01 5:30 p.m - 7:30 p.m
The information on this form is confidential and will be used only to report to the funding organizations, provide client services, inform you about and improve the REAP services. Please complete to the best of your knowledge/ability. The estimated time to fill out this form is three minutes.
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Email
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Your email
Return to: REAP WBC at
wbc@cfra.org
DATE
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MM
/
DD
/
YYYY
NAME OF TRAINING
*
Your answer
COMPANY NAME (leave BLANK if NOT in business)
Your answer
ARE YOU THE BUSINESS OWNER?
Yes
No
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FIRST NAME, MI, LAST NAME
*
Your answer
EMAIL
*
Your answer
PHONE
*
Your answer
BUSINESS ADDRESS
Your answer
HOME ADDRESS
*
Your answer
CITY
*
Your answer
STATE
*
Your answer
ZIP CODE
*
Your answer
COUNTY (NOT COUNTRY)
*
Your answer
GENDER
FEMALE
MALE
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RACE
BUSINESS ADDRESS
Native Hawaiian/Pacific Islander
Black/African American
White/Caucasian
Native American
Choose not to respond
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HISPANIC ORIGIN
Hispanic/Latino
Non-Hispanic/Latino
Choose not to respond
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VETERAN STATUS
Non-Veteran
Service Disabled
Veteran
Choose not to respond
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MILITARY STATUS
Active Duty
Military Spouse
National Guard
National Guard — Active Duty
Reservist
Reservist - Active Duty
None
Choose not to respond
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DISABLED
No
Yes
Choose not to respond
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Training Registration
The information on this form is confidential and will be used only to report to the funding organizations, provide client services, inform you about and improve the REAP services. Please complete to the best of your knowledge/ability. The estimated time to fill out this form is three minutes.
BUSINESS TYPE (Manufacturing, Construction , Agriculture, Retail, Professional Services, Accommodation & Food Services, etc.)
Your answer
DATE COMPANY WAS ESTABLISHED (approximate month and year)
Your answer
OWNERSHIP GENDER
*
FEMALE 100%
MALE 100%
50/50
NUMBER OF EMPLOYEES (Including yourself/owner) FULL TIME and PART-TIME
Your answer
GROSS REVENUE/SALES FOR MOST RECENT BUSINESS YEAR (approximate)
Your answer
COMPANY LEGAL STATUS (LLC, Sole Proprietor, S-Corp, etc.)
Your answer
Training Agreement
I am interested in further assistance. Please contact me regarding: (Select all that apply)
Start up Assistance
Business Plan Development
Business Accounting/Cash Flow
Financing/Capital
Marketing
Buy/Sell Business
Technology/Computers
Other:
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What is your family income? (This is reported to our funders as an aggregate, to help them identify the needs in Nebraska)
Below $9,999
$10,000-$14,999
$15,000-$19,999
$20,000-$24,999
$25,000-$29,999
$30,000-$39,999
$40,000-$49,999
Above $50,000
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My household size is
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Electronic signature (please sign by filling in your initials)
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Date of signed
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YYYY
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