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* 1. Full Name

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* 2. Email Address

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* 3. Business Name

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* 4. Business Location

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* 5. Type of Business (ex. grocery, hardware, retail-which kind)

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* 6. What is the current state of your business (Open, close, online only etc)

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* 7. What are your primary financial concerns at the moment?

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* 8. How long can you sustain in your current state? (how many months, days, weeks?)

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* 9. What kind of measures are you currently considering to keep your business running?

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* 10. Have you laid off or cut back on staff? How many staff do you have now, and how much do you anticipate needing to cut back?

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* 11. Do you carry insurance that covers losses related to a pandemic?

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* 12. Do you have any special skills related on online merchandising, distribution, or marketing that you would be willing to share with other neighborhood business owners?

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* 13. Does your financial structure fit the current relief program parameters? If not, what about your set up makes you ineligible?

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* 14. What measures, if any, have you taken to maintain and stabilize sales?

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* 15. How can we best serve you? One of the projects we are working on is resource aggregation. What resources could be useful to you?

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* 16. Other Comments / Concerns

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