For our next class this Fall 2014

We thank you for applying for SPRING GR services and for sharing information about you and your business. Our goal is to help budding entrepreneurs reach their economic and business goals. The information you provide gives SPRING GR the information needed to:

** Get a sense of your current goals and circumstances to provide you with the best possible services
** Raise public funding to support business development. We are required to report about who we serve, what activities we offer, and the benefits (changes) for participants
** Know how we benefit area entrepreneurs by tracking your progress over time

NOTE: We keep this information confidential. We welcome your questions, requests, and suggestions.

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* 1. Date

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* 2. First Name

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* 3. Last Name

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* 4. Other names (nicknames or previous use)

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* 5. Mailing Address Info

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* 6. Would you like to be on SPRING GR's mailing list (email and/or other mailings)?

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* 7. How did you hear about SPRING GR? (click one or more)

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* 8. Gender

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* 9. What is your age?

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* 10. Race/Ethnicity (check one or multiple)

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* 11. What is your marital status?

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* 12. What is your highest level of education completed?

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* 13. Total household income last year

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* 14. Total number of people in your household (including you)?

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* 15. Do you own your own home?

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* 16. Do you or anyone in your household currently participate in any of the following? Please check all that apply

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* 17. Please give us contact information for two (2) people we can call in an emergency or if you move:

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* 18. The following questions help assess your sense of well-being. Please indicate on a scale of 1 to 5 (1 being mostly not true and 5 being mostly true)

  1 2 3 4 5
I am satisfied with my situation in life
Improving my situation in life is important to me
I believe I can change my situation
Support and opportunities exist in my community to help me
I am confident in my abilities

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BUSINESS INFORMATION SECTION

BUSINESS INFORMATION SECTION

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* 19. My business is...

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* 20. Please describe your business or idea:

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* 21. Business Name

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* 22. Other business names used

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* 23. Business location address and contact information

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* 24. When did you make your first sale? (month and year)

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* 25. What is your business ownership structure? (legal entity)

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* 26. Do you have a business partner?

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* 27. If so, what is your business partner's name (or names)?

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* 28. Do you have a business license?

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* 29. Do you have a business checking account?

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* 30. Is your business currently breaking even (sales cover all expenses)?

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* 31. What were your total business sales (revenue) last year (over the last 12 months)?

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* 32. If you broke even, what was your profit last year (in last 12 months)?

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* 33. How much did you work at this business in the past 12 months?

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* 34. I operate this business

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* 35. How many employees, contractors or partners were paid by this business in the past 12 months (including yourself)?

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* 36. What type(s) of financing has your business used? Please check all that apply.

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* 37. What was the total amount of the funding from these sources you used to start your business?

Thank you for completing this survey! We will be in touch with you after reviewing this application.
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