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* 1. Name (First, Last)

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* 2. Business Name

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* 3. Business Address

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* 4. City

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* 5. State

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* 6. Email Address

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* 7. Phone Number

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* 8. What has been the impact thus far on your business from COVID-19?

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* 9. Is your business impacted by the travel and tourism industry?

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* 10. In a few words, tell us your most immediate business need:

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* 11. Have you decided to reduce your hours or close your business temporarily?

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* 12. If you are facing, or have already needed to lay off, how many employees will that affect?

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* 13. Are you currently hiring employees due to an increase in business?

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* 14. If you are looking to hire employees, would you like to be connected with other businesses who might be needing to lay-off their employees?

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* 15. If you are needing to lay-off employees, would you like to be connected with other businesses who might be interested in hiring your employees?

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* 16. How are you supporting your employees during this crisis? (special projects, food donations, etc)

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* 17. How are you engaging and educating your employees on COVID-19 information?

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* 18. How are you engaging and educating your customers on COVID-19 information?

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* 19. Does your company have a remote or teleworking policy that has been implemented regarding COVID-19?

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* 20. Why not?

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* 21. Does your company leave policy contain guidance for these situations?

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* 22. What is the impact on your company's workforce with schools/daycare cancelled?

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* 23. Would you like to receive additional information on financial assistance related to COVID-19?

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