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* 1. What kind of business or organization do you operate?

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* 2. Where is your business(es) located? 

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* 3. How has your business been affected by COVID-19? (Check all that apply) 

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* 4. Please provide an estimate of any lost revenue you've experienced, if applicable.

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* 5. Number of impacted employees through layoffs/adjustments in work schedules. 

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* 6. What is currently your biggest concern? (Check all that apply.)

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* 7. If business disruption continues at the current rate, is your business at risk of permanently closing?

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* 8. If at risk of permanent closure, how soon do you anticipate the closure? 

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* 9. What type of assistance/information would be most helpful to you right now? (Check all that apply) 

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* 10. If you would like to be added to an email distribution list for any updates we receive regarding COVID-19 funding and options for your business, please provide your information. 

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