DDI Business Assistance Intake Form
We’re excited to support you in growing your business and achieving your goals! This questionnaire is designed to help us better understand your needs, challenges, and aspirations. While many resources are already available, your responses will also help us identify gaps and create new programs to support the unique needs of businesses like yours. Please take a few moments to answer the questions as thoroughly as possible. This information will allow us to provide personalized assistance, connect you with valuable resources, and advocate for the needs of our business community. Thank you for helping us shape the future of our region’s economic development!
Section 1: General Information
Name
*
First Name
Last Name
Business Name (if applicable)
Business Address (if applicable)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Preferred Method of Contact (check all that apply)
*
Phone
Email
Text
In Person
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Section 2: Demographics
This section helps us understand the diversity of the businesses we serve and identify potential eligibility for specific grants and programs. Your responses are confidential and will only be used for reporting and program development purposes.
What is your age group?
*
Under 25
25-34
35-44
45-54
55-64
65+
What is your gender?
*
Female
Male
Non-Binary
Prefer not to answer
What is your ethnicity or race? (Check all that apply)
*
American Indian or Alaskan Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Other
Prefer not to answer
Please input ethnicity or race:
Do you identify as a member of any of the following groups? (Check all that apply)
*
Veteran
LGBTQ+
Person with a disability
None of the above
Prefer not to answer
What percentage of your business do you own?
100%
Majority owner (51% or more)
Minority owner (49% or less)
Prefer not to answer
Is your business certified as any of the following? (Check all that apply)
*
Women-owned business
Minority-owned business
Veteran-owned business
LGBTQIA+-owned business
Disability-owned business
None of the above
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Section 3: Goals & Needs
What is your primary reason for reaching out to DDI? (Check all that apply)
*
Seeking grant funding or financial assistance
Developing or improving a business idea
Expanding or growing my business
Accessing training, coaching, or seminars
Joining an entrepreneur club or networking opportunities
Improving the facade or aesthetics of my business
Other
Please specify:
Would you like assistance with the following aspects of business strategy or operations? (Check all that apply)
*
Identifying and prioritizing short and long-term goals
Developing or refining a business plan
Evaluating current operations and identifying inefficiencies
Exploring growth opportunities or new markets
Conducting market research or competitor analysis
Building and implementing a marketing plan
Developing key performance indicators (KPIs) to measure progress
Succession Planning
Other
Please Specify:
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Section 4: Current Capabilities
What best describes your current business stage?
*
Just an idea
Planning and research
Recently launched (1-2 years in operation)
Established business (3+ years in operation)
Looking to expand
What industry or type of business are you involved in or planning to start?
*
Doyou currently have a business plan?
*
Yes
No
In Progress
What challenges or obstacles are you currently facing in your business or project?
*
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Section 5: Workforce Development
How many employees does your business currently have?
*
Do you plan to hire employees in the near future?
*
Yes
No
What workforce challenges are you facing, and what type of support would be most helpful? (check all that apply)
Finding or recruiting qualified employees
Retaining employees
Providing training or upskilling opportunities
Understanding workforce regulations
Accessing grants or funding for workforce development
Other
Please specify:
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Section 6: Financial Commitment and Budget
DDI and partners provide many free services, but some opportunities my require a shared financial commitment. Are you open to contributing a portion of the costs for services or opportunities?
*
Yes, I'm open to considering co-sponsored opportunities
No, I'm only seeking free resources at this time
If yes, do you hav an estimated monthly budget in mind for these services?
Under $500
$500-$1000
$1000+
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Section 7: Additional Information
Are there any specific services, opportunities, or outcomes you're hoping to achieve by working with DDI?
*
How did you hear about DDI?
Website
Social Media
Referral
Other
Please Specify:
Please verify that you are human
*
Submit
Should be Empty: