Please provide some basic information about your business.

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Information provided in this survey is considered a public record and may be subject to public disclosure. For more information, see the Public Records Act, RCW Chapter 42.56. To learn more about how we manage your information, see our Privacy Statement.

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* 1. Your name

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* 2. Title

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* 3. Evening phone number

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* 4. Daytime phone number

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* 5. Email address

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* 6. Business name

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* 7. Business address

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* 8. City

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* 9. Zip/postal code

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* 10. What is the best way to reach you?

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* 11. What is the best time of day to contact you?

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* 12. What is your preferred language?

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* 13. Do you have any ADA access needs?

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* 14. Are you a low- or moderate- income business owner? "Moderate income" means less than or equal to 80% of the Area Median Income (AMI). See chart below for reference.

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* 15. Does your business have five employees or less, including you?

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* 16. Is your business a franchise, chain, startup, or restricted to patrons above the age of 18?

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* 17. Is this a woman- or minority-owned business (WMBE)?

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* 18. Please describe the destabilizing event(s) that impacted your business. These could include things like theft, vandalism, rising rents, construction, a personal emergency, or displacement. Please describe in as much detail as possible.

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* 19. What would these grant funds allow you to do that you would not otherwise be able to do? Please describe in as much detail as possible.

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* 20. What amount of grant funding is needed to stabilize your business? Briefly describe your work plan for using grant funds to stabilize your business.

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* 21. If you receive this funding, do you agree to collaborate with a stabilization coach and accept recommendations from the coach to determine how to stabilize your business?

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* 22. Does OED have your consent to register your business with the City's Online Business Directory as WMBE (Women- and Minority-Owned Businesses) - if applicable ?

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