Appendix_2_-_Demographic_and_Business_Info_Requirements.docx

Example of demographic information

1. Race (mark one or more) American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Ethnicity Hispanic or Latino Not Hispanic or Latino Gender Male or Female Do you consider yourself a person with a disability?

Yes No

2. Military Status No military, Reserve, or National Guard service Veteran Service Disabled Veteran Member of the Reserve Active Duty Member of the National Guard Spouse of Military Member

3. How did you find this service? (Mark all that apply) Magazine/Newspaper SBA District

SBDC

Other Client Word of Mouth

USEAC

Lender Business Owner

SCORE

WBC

Educational Institution Local Economic Development Official Television/Radio Boots to Business SBA Web site

VBOC

Chamber of Commerce Internet (please indicate website) Other (specify) Are you currently in business?

Yes No (skip the rest) Name of Business Are you currently exporting?

Yes No

4. Type of Business (choose primary category) Professional, Scientific & Technical Services Mining Manufacturing Real Estate & Rental & Leasing Management of Companies & Enterprises Utilities Finance & Insurance Health Care & Social Assistance Agriculture, Forestry, Fishing & Hunting Information Wholesale Trade Accommodation & Food Services Administrative & Support Construction Public Administration Arts, Entertainment & Recreation Waste Management & Remediation Services Retail Trade Educational Services Transportation & Warehousing Other Services (except Public Administration) Business Ownership – What percentage of your business is male or female owned?

__ % Male__ % Female Date Business started

(MM/YYYY)

Do you conduct business online Yes No Are you a home based business Yes No Are you 8(a) certified?

Yes No Total No. of Employees (full & PT) Of total employees, how many are engaged in the exporting aspect of your business: (Full & PT) For your most recent full business year, what were your:

Gross Revenues/Sales $ +Profits/-Losses $ Amount of your Gross Revenues/Sales related to exporting $ What is the legal entity of your business?

Sole Proprietorship Corporation LLC S-Corporation Partnership Other (specify)