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* 1. What is your first and last name?

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* 2. What is the name of your business?

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* 3. Which race/ethnicity best describes you?

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* 4. What is your age range?

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* 5. In what ZIP code is your business located?

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* 6. How worried are you about the impact of COVID-19 on your company?

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* 7. Has your business been impacted by COVID-19?

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* 8. Do you own a brick and mortar or virtual business?

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* 9. If brick and mortar, what is your business address?

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* 10. How many years has your business been operational?

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* 11. Do you operate your business part-time or full-time?

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* 12. What type of business do you operate?

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* 13. Which of the following describes your business:

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* 14. Prior to the COVID-19 crisis, how many employees did your business have at full capacity?

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* 15. How many employees does your business have at the present moment?

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* 16. How concerned are you about having adequate staffing for your business?

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* 17. Are you encouraging employees to get tested for COVID-19 and stay home while awaiting results?

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* 18. Do you have guidelines for employees reporting to work? (ie. wear masks, temperature checks, etc.)

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* 19. Have you had to close your business due to COVID-19?

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* 20. If you have not closed your business, how much longer can you operate under the current conditions?

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* 21. How do you expect COVID-19 to impact your business in the future? (check all that apply)

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* 22. If your business has reopened, have you received any warnings, fines or citations for COVID-19 violations?

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* 23. What are the TOP THREE biggest challenges your business is currently facing during the COVID-19 crisis?

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* 24. Are you regularly operating at a loss due to COVID-19 impact?

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* 25. How confident are you that you have the right resources and benefits to help support your business through this period?

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* 26. Outside of work, how confident are you that you have the right support network to help you through this period?

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* 27. Since March 1, 2020, have you received any financial support for your business (locally or nationally)?

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* 28. If so, what type of support did you receive?

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* 29. In what ways do you need financial support?

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* 30. If there were other opportunities to support your business, what type of assistance would you need? (be as detailed as possible)

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