WORC Business Assessment Survey

Thank you for your interest regarding the COVID-19 PA STATEWIDE GRANT PROGRAM recently announced by Governor Wolf. We at WORC are one of the 17-member CDFIs that make up the PA CDFI Network and will be administering this program. Please note that this is not the application form, but an assessment of your overall business needs.

You will be able to access the application via our website, http://worc-pa.com, or at pabusinessgrants.com, through which businesses can learn more about the program, the CDFIs deploying the grants, and select WORC as their lender. As of June 30, 2020 applications are being accepted. The first round will stay open for 10 business days. There are expected to be multiple rounds of funding. Again, this survey is to connect with WORC for additional business and financial services.

First, let us tell you about WORC:

Women's Opportunities Resource Center (WORC) mission is to promote social and economic self-sufficiency primarily for economically disadvantaged women and their families--men are welcome as well--ultimately, all business owners can apply to this program through WORC. WORC provides training, individual business assistance, incentive savings program, loans, and access to business and financial resources.

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* 1. We expect that the following documentation will be required for the grant application in electronic form. Please click the forms below that you have readily available in electronic form:

Most recent tax returns (2018 or 2019) or 2020 Interim Financials through 3/31/2020 (if the business is a start-up)

Explanation of how COVID-19 negatively affected your business

Explanation of how you plan to spend the funds (must be expenses incurred because or related to COVID-19)

Legal documents confirming Pennsylvania registration: Articles of Incorporation; Doing Business As (DBA Form), Activity License, etc.

Attest that the business is current on all State and Federal Taxes

Bank account information and recent statement

A list of other grants or awards the business has received during the pandemic (Payroll Protection Program (PPP), Emergency Disaster Loan (EDL), City of Philadelphia grants, etc.)

Government identification in electronic form (e.g. drivers license, passport, green card, etc.)

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* 2. Do you have the capacity to upload documents electronically without help?

Yes

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* 3. What is the Legal Business Name:

Legal Business Name:

What is your Doing Business As (DBA) Name, if applicable:

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* 4. What is the physical location of your business?

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Phone Number

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* 5. What best describes your business industry type?

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* 6. Please describe your business in further detail (ex. auto mechanic, ice cream store, wholesale bakery, law firm, etc.):

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* 7. What is your overall household income?:

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* 8. How many years has your business been in operation?

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* 9. What are your business yearly revenues (based on most recent tax returns/numbers)?:

2018:

2019:

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* 10. Please provide your contact information:

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 11. Please provide your business website if you have one:

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* 12. Does your business have E-Commerce capability:

Yes

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* 13. Is your business ownership 51% or more:

African American

Pacific Islander

Asian

Hispanic

Native American

None of the above

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* 14. Is your business ownership at least 51% or more women owned?:

Yes

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* 15. Was your business allowed to open anytime during the period of March 16-June 5, 2020?:

The business was completely closed through June 5th

The business was partial closed through June 5th

The business was open at any point prior to June 5th

If you were closed or partially closed, why?

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* 16. If you were partially open, please explain in further detail. If you were legally allowed to open or partially open but decided not to open, please explain the reason.

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* 17. Were you profitable or roughly break-even before COVID-19?:

I was profitable on my most recent tax returns

I was roughly break-even on my most recent tax returns

I experienced a loss on my most recent tax returns

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* 18. For Start-Ups and New Ventures (businesses that began operating after January 1, 2020)

I am a start-up and experienced losses on my interim financials

I am a start-up and experienced break-even or profits on my interim financials

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* 19. How has COVID-19 negatively affected your business?

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* 20. What was your loss of revenue due to the COVID-19 pandemic?

75%-100% loss of revenues

50%-75% loss of revenues

25%-50% loss of revenues

0%-25% loss of revenues

No loss of revenue

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* 21. Are you able to meet your business and/or personal expenses?

Able to meet business and personal expenses

Able to meet business expenses but not personal expenses

Able to meet personal expenses but not business expenses

Cannot meet business or personal expenses

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* 22. Based on today's circumstances, what dollar amount are you short on your current combined monthly expenses, if any?

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* 23. Please describe your plan for re-opening or pivoting your business:

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* 24. Please list any other funds that you have received during the pandemic:

Payroll Protection Program PPP

Emergency Disaster Loan EDL

Other Loans

City or County Grant

Business Loan or WORC Loan

Other Grants

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* 25. Please provide the amount(s) that you have received on any of the funds clicked on the above question #23

PPP Amount:

EDL Amount:

City or County Grant Amount:

Business Loan or WORC Loan Amount:

Other Grants Amount:

Other Loan Amount:

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* 26. If you received funds to help your business through the pandemic, how did you spend the funds? Please explain by fund type. Include if you have any funds remaining and amount?
Example: If you applied for an Emergency Disaster Loan to cover May and June rents, you cannot apply for this loan to also cover May and June rents)

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* 27. How does this upcoming request for a PA CARES Grant and use of funds differ from previous funds?
(Please remember you cannot request funds for the same expenses.)

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* 28. How much additional funding - and for what materials - do you think you will need to successfully re-open and/or pivot your business?

PPE (masks, gloves, etc)

Cleaning & sanitation

Reconfiguration of space

Supplies or new equipment

Monthly working capital (money to cover cash flow, cash safety net, etc.)

Past due debts

Other expenses

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* 29. Please provide the amounts of the funding needed for any of the items checked in above question #26:

PPE (masks, gloves, etc) Amount:

Cleaning & sanitation Amount:

Reconfiguration of Space Amount:

Supplies or New Equipment Amount:

Monthly Working Capital (money to cover cash flow, cash safety net, etc.) Amount:

Past Due Debts Amount:

Past Due Rent Amount:

Other Expenses Amount:

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* 30. How would you plan to spend the additional grant funds for COVID-19 related expenditures and/or past due expenses:

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* 31. Do you have a bookkeeping system?

Yes

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* 32. Do you have an accountant?

Yes

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* 33. Please share your accountant's contact information if willing. If not, simply skip the question:

Name:

Street Address:

City:

State:

Zipcode:

Phone Number:

Email address:

Website:

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* 34. Basic Financial Analysis: Cash vs. Money Owed

Total Current Cash in Business Bank Accounts:

Total Current Business Debts:

Current Past Due Bills (rent, loans, taxes, payroll, other):

Current Personal Savings That Can Be Used for Business Expenses:

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* 35. Basic Financial Analysis: P&L Pre-COVID Crisis

Monthly Sales/Revenue (Average):

Monthly Expenses (Average):

Monthly Profits or Losses (Average):

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* 36. Basic Financial Analysis: P&L During COVID Crisis

Monthly Sales/Revenue (Average):

Monthly Expenses (Average):

Monthly Additional Expenses Related to COVID-19 (Average):

Monthly Profits or Losses (Average):

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* 37. WORC is able to provide additional financing assistance. This includes microloans ranging from $1,000 to $50,000 - please note, any new SBA funded loans issued by September 30, 2020 are eligible to have six months of interest and principal paid for by the SBA. Please check off any categories that you are interested in:

Assistance applying for a PPP loan or EDL loan

Micro-loan (up to $50,000) through WORC

Real estate loan to help businesses purchase commercial property (up to $250,000)

Emergency Savings Program (incentivized saving program)

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* 38. WORC also provides business assistance to help businesses grow, increase their profits, and tighten up their operations and processes. Please check below, any assistance your business may need.

Help changing business model post COVID-19 to adjust for social distancing, decreased seating capacity, etc.

Help with bookkeeping, understanding my business financials, and cash flow

Help with website design, E-commerce, or integrating E-commerce with current bookkeeping system

Help with employees, employee development, payroll processing, or anything related to hired help

Help with landlord and/or lease issues

Help purchasing PPE (masks, plastic barriers, etc) and/or understanding COVID-19 regulations

Help to create a new business plan

Help with payment plans and catching up on bills

Help with Marketing and Advertising

Help purchasing property where you can operate your business (existing property or new)

Other help needed:

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* 39. Are you an existing WORC client?

Yes

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* 40. If you are an existing WORC client, what type of assistance did you receive from WORC?

Technical Assistance

Loan(s)

Emergency Savings

WORC Business Assessment Survey

Question Title

* 1. We expect that the following documentation will be required for the grant application in electronic form. Please click the forms below that you have readily available in electronic form:

Question Title

* 2. Do you have the capacity to upload documents electronically without help?

Question Title

* 3. What is the Legal Business Name:

Question Title

* 4. What is the physical location of your business?

Question Title

* 5. What best describes your business industry type?

Question Title

* 6. Please describe your business in further detail (ex. auto mechanic, ice cream store, wholesale bakery, law firm, etc.):

Question Title

* 7. What is your overall household income?:

Question Title

* 8. How many years has your business been in operation?

Question Title

* 9. What are your business yearly revenues (based on most recent tax returns/numbers)?:

Question Title

* 10. Please provide your contact information:

Question Title

* 11. Please provide your business website if you have one:

Question Title

* 12. Does your business have E-Commerce capability:

Question Title

* 13. Is your business ownership 51% or more:

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* 14. Is your business ownership at least 51% or more women owned?:

Question Title

* 15. Was your business allowed to open anytime during the period of March 16-June 5, 2020?:

Question Title

* 16. If you were partially open, please explain in further detail. If you were legally allowed to open or partially open but decided not to open, please explain the reason.

Question Title

* 17. Were you profitable or roughly break-even before COVID-19?:

Question Title

* 18. For Start-Ups and New Ventures (businesses that began operating after January 1, 2020)

Question Title

* 19. How has COVID-19 negatively affected your business?

Question Title

* 20. What was your loss of revenue due to the COVID-19 pandemic?

Question Title

* 21. Are you able to meet your business and/or personal expenses?

Question Title

* 22. Based on today's circumstances, what dollar amount are you short on your current combined monthly expenses, if any?

Question Title

* 23. Please describe your plan for re-opening or pivoting your business:

Question Title

* 24. Please list any other funds that you have received during the pandemic:

Question Title

* 25. Please provide the amount(s) that you have received on any of the funds clicked on the above question #23

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* 27. How does this upcoming request for a PA CARES Grant and use of funds differ from previous funds? (Please remember you cannot request funds for the same expenses.)

Question Title

* 28. How much additional funding - and for what materials - do you think you will need to successfully re-open and/or pivot your business?

Question Title

* 29. Please provide the amounts of the funding needed for any of the items checked in above question #26:

Question Title

* 30. How would you plan to spend the additional grant funds for COVID-19 related expenditures and/or past due expenses:

Question Title

* 31. Do you have a bookkeeping system?

Question Title

* 32. Do you have an accountant?

Question Title

* 33. Please share your accountant's contact information if willing. If not, simply skip the question:

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* 34. Basic Financial Analysis: Cash vs. Money Owed

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* 35. Basic Financial Analysis: P&L Pre-COVID Crisis

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* 36. Basic Financial Analysis: P&L During COVID Crisis

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* 38. WORC also provides business assistance to help businesses grow, increase their profits, and tighten up their operations and processes. Please check below, any assistance your business may need.

Question Title

* 39. Are you an existing WORC client?

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* 40. If you are an existing WORC client, what type of assistance did you receive from WORC?

Question Title

* 27. How does this upcoming request for a PA CARES Grant and use of funds differ from previous funds?
(Please remember you cannot request funds for the same expenses.)