Client Intake Survey

The following is a brief 10 minute survey that we ask you to complete in advance of your first consultation with our coaching team. The information you provide will help us get to know more about you, your business, and how we can best assist you on your journey. Any personal information you provide is kept confidential. Let's get started!

Contact Information

Please verify or update your contact information
Business Address (if applicable)

About Your Business

The following questions help us get a sense of what kind of business you have, your needs, and additional resources that may be available for your specific type of business such as grant opportunities or government assistance programs.
What type of business do you operate?(Required)
Business Formation(Required)

How many years have you been in business?(Required)

Please include the number of Full-time, Part-time, and Seasonal workers if applicable.
Is your annual revenue over $1 million?(Required)

Do you currently hold another job in addition to running your own business?(Required)

Goals and future plans for your business

Are you planning to expand your business? (Check all that apply)(Required)
Examples may include lost revenue, employees laid off, lost profits, etc.

Demographic Information

In order for RCAP to continue offering free technical assistance and coaching to small businesses, our funders need to know that we are reaching the businesses our grants are intended to serve. Please help us continue supporting small businesses like you by answering the following demographic questions. The information you provide is strictly anonymous, your name and contact information is never associated with any data reported to our funders. Thank you!
How would you best describe yourself?(Required)
To which gender identity do you most identify?(Required)

Is your business owned, managed, or controlled by individuals from any of the following categories? (select all that apply)(Required)
There may be additional grant programs and forms of government assistance available to businesses that fall into these categories.
Age Range(Required)
What is the highest level of education you've completed?(Required)
Household Income Range(Required)
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