Below is the WBC Survey Instrument – This survey will be conducted through a web based system.
Assistance received
When did you first receive business assistance or training from [WBC name]?
_ _ _ _ (yyyy)
During 2012, what type of business assistance and training did you receive from [WBC name]? (select all that apply)
□ Classroom training
□ Online training
□ One-on-one counseling
□ Referral/connection to WBC affiliate for mentoring, coaching, consultation, etc.
□ Other (please specify) __________
Please estimate how many total hours of business assistance and training you received during 2012.
□ 0
□ 1–2 hours
□ 3–5 hours
□ 6–8 hours
□ 9–10 hours
□ More than 10 hours
Did you receive business assistance or training from other organizations during 2012? (select all that apply)
□ Small Business Development Center
□ SCORE
□ Other (please specify)______________
Have you received business assistance or training from [WBC name] or another organization since 2012?
□ Yes
□ No
Assistance Impact
As a result of the assistance or training you received from [WBC name], have you changed any of your business decisions, practices or strategies?
□ Yes
□ No
To what extent do you agree or disagree with the following statements?
|
Strongly Agree |
Agree |
No opinion |
Disagree |
Strongly Disagree |
My experience with [WBC name] helped me to: Increase my confidence |
5 |
4 |
3 |
2 |
1 |
Access a trusted advisor |
5 |
4 |
3 |
2 |
1 |
Start/increase my savings |
5 |
4 |
3 |
2 |
1 |
Increase my self-sufficiency |
5 |
4 |
3 |
2 |
1 |
Increase my household income |
5 |
4 |
3 |
2 |
1 |
Consider growing my business |
5 |
4 |
3 |
2 |
1 |
To what extent do you agree or disagree with the following statements? - If you have not yet started your business, please skip to question 9.
|
Strongly Agree |
Agree |
No opinion |
Disagree |
Strongly Disagree |
The assistance I received from [WBC name] helped me to: Start my business |
5 |
4 |
3 |
2 |
1 |
Increase my sales |
5 |
4 |
3 |
2 |
1 |
Obtain financing |
5 |
4 |
3 |
2 |
1 |
Increase my profit margin |
5 |
4 |
3 |
2 |
1 |
Hire new staff |
5 |
4 |
3 |
2 |
1 |
Other (specify____________) |
5 |
4 |
3 |
2 |
1 |
Overall, how helpful were the services you received from [WBC name]?
□ Very helpful
□ Somewhat helpful
□ Slightly helpful
□ Not at all helpful
Would you recommend [WBC name] to a friend or business associate?
□ Yes
□ No
Getting Started1
When you sought assistance from [WBC name] in 2012, were you:
□ Just considering a business idea – SKIP next
□ In the process of starting a business – SKIP next
□ Already in business – GO TO next
When did you start or acquire your business? SKIP next
_ _ _ _ (yyyy)
Did you start or acquire your business during or since 2012?
□ Yes – GO TO next
□ No – SKIP next and next section
Are you currently operating this business?
□ Yes – SKIP next
□ No – GO TO next
What is the primary reason you are no longer operating this business?
□ Business was not financially viable
□ Personal circumstances (e.g. prefer a wage job, illness, moved)
□ Business was sold
□ Other (please specify) __________
Which of the following best describes the industry or sector in which your business operates?
□ Personal service (e.g. salon, computer repair, wedding planning)
□ Professional service (e.g. accounting, medical, management consulting)
□ Construction (e.g. plumbing, electrician, construction)
□ Retail trade (e.g. clothing, florist, convenience store, car dealer)
□ Hospitality, art, entertainment (e.g. food, lodging, event promotion, performing arts)
□ Social assistance (e.g. day care, youth services, community food services)
□ Educational service (e.g. school, trade program, test preparation service)
□ Manufacturing (e.g. food, furniture, clothing)
□ Other (please specify) __________________
What is the geographic location of your business operations?
□ Rural area
□ Urban area
□ Suburban area
Business Statistics
Were you operating your business during any part of 2012 or 2013?
□ I was operating my business for all or parts of BOTH 2012 and 2013
□ I was operating my business for all or parts of 2012 only
□ I was operating my business for all or parts of 2013 only
Including yourself and other owners, how many people did you employ at the end of each of the calendar years below? (Please complete only for the years you operated; leave others blank.)
IF Q11 was CHOICE a or b and Q13 was CHOICE no, SKIP TO Q21
2013
Number of full-time paid employees (35 hours or more per week) ______
Number of part-time paid employees (fewer than 35 hours per week) ______
Number of independent contractors (including full- and/or part-time) ______
2012
Number of full-time paid employees (35 hours or more per week) ______
Number of part-time paid employees (fewer than 35 hours per week) ______
Number of independent contractors (including full- and/or part-time) ______
What was the approximate gross sales revenue of your business during each of the calendar years below? (Please complete only for the years you operated; leave others blank.)
All data will be held in strict confidence and reported only in the aggregate without identifying any individual respondent.
2013: $____________
2012: $____________
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|
|
|
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If you applied for financing for your business in 2012 or 2013, what was the primary reason?
□ I did not apply for new financing – SKIP TO next section
□ To start or acquire my business – GO TO next
□ To accommodate growth in my business – GO TO next
□ To manage working capital, support cash flow – GO TO next
□ To make a capital investment – GO TO next
□ Other – GO TO next
Did you obtain new financing for your business in 2012 or 2013?
□ Yes – GO TO next
□ No – SKIP next
Estimate the total amount of new financing your business obtained from the following sources in 2012 and 2013?
All data will be held in strict confidence and reported only in the aggregate without identifying any individual respondent.
Loan from a commercial bank or credit union – GO TO next $____,____.00
Loan from a non-bank, community lender– SKIP next $____,____.00
Loan from friends or family – SKIP next $____,____.00
Loan from [insert WBC name] – SKIP next $____,____.00
Other debt acquired or investor equity raised (please specify)__– GO TO next $____,____.00
Please estimate the percentage of total financing that was a Small Business Administration guaranteed loan.
_________%
Background Information
Please indicate your gender:
□ Female
□ Male
Please indicate your military service:
□ None
□ Veteran
□ Service Disabled Veteran
□ Active Duty
□ National Guard or Reservist
Do you consider yourself a person with a disability?
□ No
□ Yes
Please indicate your race or origin (select one or more):
□ American Indian or Alaskan Native
□ Asian
□ Black or African American
□ Hispanic or Latino
□ Native Hawaiian of Other Pacific Islander
□ White
□ Other race (please specify)______________
Please indicate your current age:
□ 18 – 24
□ 25 – 34
□ 35 – 44
□ 45 – 54
□ 55 – 64
□ 65 – 74
□ 75+
At the time that you first sought services from [insert WBC name], what was your employment status?
□ Self-employed
□ Employed full-time for another company
□ Employed part-time for another company
□ Unemployed
□ Other
At the time that you first sought services from [insert WBC name], how many adults and children were living in your household?
□ 1
□ 2
□ 3
□ 4
□ 5
□ 6
□ More than 6
At the time that you first sought services from [insert WBC name], what was your approximate total household income?
□ Less than $11,000
□ $11,000 - $19,000
□ $19,001 – $31,000
□ $31,001 - $50,000
□ Over $50,000
WRAP-UP
Is there anything else you would like to share about yourself, your business, your experience with [insert WBC name], or ways to improve the program?
If you would like to participate in the raffle for a chance to win 1 of 500 coupons for Ben and Jerry’s Ice Cream, please provide your address so that it can be mailed to you in the event that you are selected.
1 Skip patterns are indicated by capital letters (i.e. GO TO; SKIP).
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Saara Hussain |
| File Modified | 0000-00-00 |
| File Created | 2021-01-25 |