Thank you for sharing information prior to one of our lenders reaching out. We will use this information to determine how LISC can be of assistance to you. For business owners with multiple businesses, please answer this questionaire for one business only.  Please email SmallBusiness@lisc.org for questions and troubleshooting.
Eligibility is based on accurate and complete submission of request to include required documents uploaded. This program is not eligible to employees of State Farm or LISC. 

Please note that this web page may not save your work if you leave the website before completing and submitting the questionnaire. You may also lose your work if your internet is disconnected, or as a result of other potential web browser issues. We recommend respondents save their answers in a separate document as a backup in case their work in progress on this page disappears for any  reason.

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* 1. Business Owner

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* 2. Business Information

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* 3. Legal Structure of Business

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* 4. What is your primary Industry?

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* 5. Years in business

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* 6. What was your organization's gross income in calendar year 2019 (1/1/2019 to 12/31/2019)?

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* 7. Is your business registered and in good standing with the State of Illinois?

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* 8. Does your company have any Certifications (eg, MBE/WBE/VBE/DBE)? 

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* 9. Number of employees prior to December 31, 2019

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* 10. Number of employees after April 1, 2020

The next portion of the survey requests socio-economic data and is required for this grant. Please provide information based on how you self-identify.  
Information provided through this questionnaire process is the responsibility of each applicant. Questionnaire submitted to the portal remain confidential to the general public and any fellow applicants. Applicants will not hold LISC or, its affiliates, members, partners and staff liable for any losses, damages, costs, or expenses, of any kind relating to the use or the adequacy, accuracy, or completeness of any information loaded in the form.
Link to LISC's Privacy Policy

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* 11. Age

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* 12. Race/Ethnicity (Please specify)

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* 13. Gender

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* 14. Veteran

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* 15. How did you hear about program?

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* 16. Do you own or lease your current business location?

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* 17. If lease, has your landlord offered any rent concession or extensions?

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* 18. Are you concerned about your ability to pay your bills in April or beyond?

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* 19. Are you still able to sell your product/services?

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* 20. Please describe the direct and indirect ways COVID-19 has impacted your revenue (i.e. overhead and fixed expenses, local shut down requirements, etc.)

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* 21. Is your local government mandating that you close or limit your services or hours of operation?

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* 22. Is your organization's work considered "essential"?

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* 23. What alternative services are you offering in light of COVID-19?

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* 24. Please check all that apply:

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* 25. Have you applied for any of the following aid due to the impact of COVID-19?

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* 26. Do you have any loans/UCC liens on the business/organization?

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* 27. Are you receiving extensions from lenders?

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* 28. General comments or any other information you would like to share with us:

Please click "Done" below, to confirm your application was received. If you do not advance on the next page after clicking Done, please review the survey above for incomplete entries, which will be denoted by "!" and messages on what to fix.
Please email SmallBusiness@lisc.org for questions and troubleshooting.

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