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Technical Assistance Survey (CONFIDENTIAL)
*
1.
Contact Information
(Required.)
Name
Business
Business Address
City/Town
ZIP/Postal Code
Email Address
Phone Number
*
2.
Do you reside in Vancouver?
(Required.)
Yes
No
*
3.
Has your business been impacted by COVID-19?
(Required.)
Yes
No
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.)
Parklet & Sidewalk Café Assistance
Online Presence Development (Website, E-commerce, Social Media)
Shop Safely Marketing Campaign
n/a
*
7.
Demographic Information: Race (please check all that apply)
(Required.)
American
Asian
Black / African American
White
Hispanic
No Response
*
8.
Gender
(Required.)
Male
Female
Non-binary
*
9.
What is your annual household income? use slider or input in box (CONFIDENTIAL)
(Required.)
0
250,000
Clear
*
10.
Source of Income (for example: job, own business, social security, retirement, etc)
(Required.)
*
11.
What is your household size?
(Required.)
1
2
3
4
5
6
7
8
12.
Household Information
Special Needs Household?
Disabled Household?
Homeless?
n/a
*
13.
By typing my legal name, I certify that this information is complete and accurate.
(Required.)
Current Progress,
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