Thank you for your interest in receiving help with the U.S. Small Business Administration's (SBA) Paycheck Protection Program (PPP).

Please provide the following information to us so that we can respond according to your needs. We will do our best to respond as quickly as we can.

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* 1. First Name

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* 2. Last Name

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* 3. Business/Program Name

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* 4. Your Title/Role

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* 5. Your Email

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* 6. Your Phone Number

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* 7. Type of Care

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* 8. Have you applied for the PPP already?

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* 9. How is your business structured?

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* 10. Does your business have employees? How many were employed before the COVID-19 crisis?

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* 11. As of today, how many employees or contractors have been laid off, furloughed or are receiving no pay / taking no salary?

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* 12. What specific support(s) on the Paycheck Protection Program (PPP) are you looking for? (check all that apply)

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* 13. Please let us know what specific questions on PPP you have:

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* 14. Do you have a current relationship with a bank? (which usually means that you have a business account with that bank)

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* 15. If yes, which bank?

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* 16. Do you need information in a language other than English?

Please note that we may not be able to accommodate all requests for language support.

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* 17. How do you prefer we get in touch with you?

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* 18. Is your business a woman-owned and/or minority-owned business?

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* 19. Any other comments?

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