Technical Assistance Survey (CONFIDENTIAL)

Question Title

1. Contact Information (Required.)

Name

Business

Business Address

City/Town

ZIP/Postal Code

Email Address

Phone Number

Question Title

2. Do you reside in Vancouver? (Required.)

Yes

Question Title

3. Has your business been impacted by COVID-19? (Required.)

Yes

Question Title

4. Please describe impact (e.g sales are down ___%)

Question Title

5. How long have you been in business?

Question Title

6. What type of technical assistance are you interested in? (Required.)

Parklet & Sidewalk Café Assistance

Online Presence Development (Website, E-commerce, Social Media)

Shop Safely Marketing Campaign

n/a

Question Title

7. Demographic Information: Race (please check all that apply) (Required.)

American

Asian

Black / African American

White

Hispanic

No Response

Question Title

8. Gender (Required.)

Male

Female

Non-binary

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9. What is your annual household income? use slider or input in box (CONFIDENTIAL) (Required.)

250,000

Clear

i We adjusted the number you entered based on the slider’s scale.

Question Title

10. Source of Income (for example: job, own business, social security, retirement, etc) (Required.)

Question Title

11. What is your household size? (Required.)

Question Title

12. Household Information

Special Needs Household?

Disabled Household?

Homeless?

n/a

Technical Assistance Survey (CONFIDENTIAL)

Question Title

* 1. Contact Information (Required.)

Question Title

* 2. Do you reside in Vancouver? (Required.)

Question Title

* 3. Has your business been impacted by COVID-19? (Required.)

Question Title

* 4. Please describe impact (e.g sales are down ___%)

Question Title

* 5. How long have you been in business?

Question Title

* 6. What type of technical assistance are you interested in? (Required.)

Question Title

* 7. Demographic Information: Race (please check all that apply) (Required.)

Question Title

* 8. Gender (Required.)

Question Title

* 9. What is your annual household income? use slider or input in box (CONFIDENTIAL) (Required.)

Question Title

* 10. Source of Income (for example: job, own business, social security, retirement, etc) (Required.)

Question Title

* 11. What is your household size? (Required.)

Question Title

* 12. Household Information

Question Title

* 13. By typing my legal name, I certify that this information is complete and accurate. (Required.)

1. Contact Information (Required.)

2. Do you reside in Vancouver? (Required.)

3. Has your business been impacted by COVID-19? (Required.)

4. Please describe impact (e.g sales are down ___%)

5. How long have you been in business?

6. What type of technical assistance are you interested in? (Required.)

7. Demographic Information: Race (please check all that apply) (Required.)

8. Gender (Required.)

9. What is your annual household income? use slider or input in box (CONFIDENTIAL) (Required.)

10. Source of Income (for example: job, own business, social security, retirement, etc) (Required.)

11. What is your household size? (Required.)

12. Household Information

13. By typing my legal name, I certify that this information is complete and accurate. (Required.)