Small Business Development Survey

1. Small Business Development Survey - Contact Information

The following information will be used to track job creation and the level of success of the small business development programs available through Community Action Agency. Please complete this survey and either submit it to our website at www.caaofcc.org or mail original by March 1, 2010.

1. Please fill in.

Please fill in. Business Name
Is the business still open? (yes/no)
If no, reason for closing
Current Address line 1
Current Address line 2
Phone Number

2. Note: Please include yourself in the following two totals.

Note: Please include yourself in the following two totals. Number of Full time employees
Number of Part time employees

3. For the questions 3-6, please list the number of employees that apply to the following categories.
Note: Please count 2 part time employees as 1 full time equivalent employee for this section.

Race

For the questions 3-6, please list the number of employees that apply to the following categories. Note: Please count 2 part time employees as 1 full time equivalent employee for this section. Race American Indian/Alaskan native
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
White

4. Ethnicity

Ethnicity Hispanic or Latino
Not Hispanic or Latino

5. Gender

Gender Male
Female

6. Income

Income Number of low income employees

7. Training

Please mark any of the following trainings that you would be interested in attending:

Training Please mark any of the following trainings that you would be interested in attending: Household budgeting

QuickBooks

General Bookkeeping

Business Insurance Basics

Marketing

How to analyze financial statements

Consumer protection issues and laws

Business Taxes 101

Managing employees

Computer Basics

Website design

8. Please list any additional training/technical support that you would interested in:

Please list any additional training/technical support that you would interested in: 1
2
3

9. We would like to hear how things are going, please give us a brief update on your business and your successes:

We would like to hear how things are going, please give us a brief update on your business and your successes: 1
2
3
4
5

THANK YOU FOR YOUR TIME.
If you have any questions, please feel free to contact Marti at 330-424-4013 or email grimm@caaofcc.org.

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