COVID Navigation Intake
Complete a short intake form and schedule your COVID Navigation session after you complete the form. Thank you! All information provided is confidential!
Please enter your name.
What is your company's name?
What is your preferred email address to receive our email communications?
What is your work phone number?
How has the COVID crisis impacted your business?
What are your needs?
Help getting service or product online
Employee Mgmt Advice
Getting bills delayed
Urgent cash for personal needs
Please describe any additional needs you may have.
How many part-time jobs (less than 35 hours per week) does your business have?
How many full-time paid employees (35 hours or more per week) does your business have?
What legal structure do you have for your business? (Sole proprietorship, LLC, Partnership, Corporation etc.)
Not for profit
Please provide your annual sales revenues (if any) for the last fiscal/calendar year.
How did you hear about us? If referred, please include the specific organization name.
This demographic information is optional, but it will help us make the appropriate matches for grant and loan opportunities.
We also collect certain demographic information in order to provide anonymized statistics about the prevalence of various types of entrepreneurs in the Bay Area to service providers and funders.
All information provided is confidential.
How do you describe yourself? (Check all that apply)
American Indian or Alaska Native
Black or African American
Native Hawaiian or other Pacific Islander
What is your ethnicity?
Please enter your home address five digit zip code.
Please enter your business address five digit zip code.
What is your birthdate?
Do you consider yourself to be LGBTQ?
Which gender do you identify most?
Prefer not to answer
Do you identify as an immigrant?
Prefer not to answer
What is your annual household income?
How many people live in your household?
How many children under 18 live in your household?
Hit the submit button and you are done. Don't forget to schedule a session with us here: https://bit.ly/schedulecovidsession