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!
1. Please enter your name. *
 
 
 
 
 
6. What are your needs?
 
 
 
 
10. What legal structure do you have for your business? (Sole proprietorship, LLC, Partnership, Corporation etc.)
 
 
 

Demographics

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.
13. How do you describe yourself? (Check all that apply)
 
14. What is your ethnicity?
 
 
 
 
18. Do you consider yourself to be LGBTQ?
 
19. Which gender do you identify most?
 
20. Do you identify as an immigrant?
 
21. What is your annual household income?
 
 
 
Hit the submit button and you are done. Don't forget to schedule a session with us here: https://bit.ly/schedulecovidsession