Cook County Small Business Source Business Advising Form

Business Name *

First Name *

Last Name *

Email *

Phone *

Role *

Owner

Employee

Other

What is your race/ethnicity? (Select all that apply) *

To determine your eligibility for assistance, please select the choice(s) that apply to your business from the following criteria: *

Where is your business located? *

Primary Business Address *

City *

State *

Country

Zip or Postal code *

Is your business at least 51% majority-owned by a person that identifies as a woman or persons that identify as women? *

Is your business at least 51% majority-owned by a member/members of the LGBTQ+ community? *

Is your business at least 51% majority-owned by by a Veteran? *

Is your business at least 51% majority-owned by a person with a disability? *

Is your business at least 51% majority-owned by a minority race/ethnic group (American Indian, Asian, Black, Hispanic, Native American)? *

What industry is your business in? *

How many employees does your business have? Include both full-time and part-time employees *

How many years have you been in business? *

Preferred Language *

Were you referred to this program from any of these partner organization? *

What is the primary nature of the business assistance you are seeking? *

What is the secondary nature of the business assistance you are seeking? (select all that apply) *

Please provide a more detailed description of the type of business assistance you are seeking (optional) *

Are you interested in group advising?

How did you hear about the Cook County Small Business Source? *