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* 1. Contact Information

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* 2. Do you reside in Vancouver?

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

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

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* 5. How long have you been in business?

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

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

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* 8. Gender

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

0 250,000
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i We adjusted the number you entered based on the slider’s scale.

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

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* 11. What is your household size?

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* 12. Household Information

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

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