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Are you a Mom Who Is Running An Employer-based Small Businesses? Take this quick survey to determine eligibility for the Kitty Fund, named after Catherine (Kitty) Abrams Tadlock Webster.

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* 1. First Name:

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* 2. Last Name

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* 3. Email Address:

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* 4. Do you identify as female?

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* 5. What diverse ethnicity do you identify as, select one?

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* 6. Do you identify as LGBTQ?

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* 7. Are you a mom?

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* 8. Number of children you have?

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* 9. Share your favorite Mothers’ Day memory?

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* 10. Are You based in US?

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* 11. Name of Company

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* 12. Company website or Facebook page?

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* 13. Business Zipcode:

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* 14. Do You Run Your Business

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* 15. Annual Revenues for 2020

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* 16. Number of Employees (Including you)? – Select One

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* 17. What Industry?

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* 18. Do you work with a bookkeeper/accountant to support your business?

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* 19. Do you use a payroll service to support your business?

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* 20. Was Your Business Impacted by COVID-19?

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* 21. How Where You Impacted: (Select All That Apply)

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* 22. If Loss of Revenue, Select One

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* 23. If loss of customers, specify. Please indicate number of customers lost

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* 24. If loss of employees, specify. Please indicate number of employees lost

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* 25. Any Other COVID Hardships You Which To Share:

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* 26. Are You Able To Pay Your Personal Wages Because of COVID 19

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* 27. Number of Months You have available to sustain your business because of Covid-19

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* 28. Did you apply for either the PPP or Emergency Disaster Loan? Specify

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* 29. Okay to stay in contact to share other resources

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