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Add or Update Your Business Information

Women's Initiative graduates,

We want to know what is going on with your business now that you have completed our training program. Filling out this form gives us a better understanding of the outcomes of our program and helps us better serve the needs of our graduates. In addition, this information allows us to link you to special marketing and promotional opportunities.

Thank you for supporting our work and letting us better serve you.


	* Email:
	Secondary Email Address (cc Email):
	* Name of Your Business:
	* First Name:
	* Last Name:
	Job Title in Your Own Business:
	* Address Line 1:
	Address Line 2:
	* City:
	* US State/Canadian Province:
	* Zip (Postal Code):
	* Address Type:
	Home Phone:
	* Your Business Phone:		Ext.
	Fax:
	Business Web Address:

What is your date of birth? (for verification purposes only)

mm	dd	yyyy

What year did you graduate from Women's Initiative?

Previously used name / Maiden Name?

Description of your business (in 50 words or less) as you wish it to appear in directories and other promotional material:

NOTE: Filling out this section does not guarantee that you will be offered placement in the directory or other promotional material

* Check the category that best describes the business or business idea you described above.

If other, please describe in a few words:

* I would like my business to be published in the Women’s Initiative Business Directory 2006 and on the Women’s Initiative website.

* What is the name of your own business (as you'd like it to appear in the Directory)?

I am interested in other promotional opportunities available through Women's Initiative.

I have a business storefront (not a home-based business) and I would like to be included in a map of Women's Initiative graduate businesses. Due to constraints of the mapping area we may not be able to accommodate all businesses.

Your answers to the following questions are required to help us determine your eligibility for the client directory, but your responses will remain completely confidential and will not be printed in the directory. We use this data to determine your business status, to report trends, and to continually improve our core training and post training services.

Where do you operate your business? You may select more than one.
(hold down the CTRL key while clicking to select more than one).

If other, please describe in a few words:

* Who do you sell your product or service to? You may select more than one...
(hold down the CTRL key while clicking to select more than one).

What type of business structure do you have?

* Do you have customers / clients and are you making fairly consistent sales? (consistent is defined by the client's goals, industry, and business model)

If yes, please answer all the questions below:
I have been making consistentsales since: (mm-dd-yyyy)
This is considered your start-up date. Given that date,

I would describe my operating systems as:

If no, please answer all the questions below:
I haven’t started my business or am not making consistent sales because:

If you answered "closed" above, please give date and explain:

If you answered "on hold" above, please give date and explain:

If you are not planning to start your business in the next year, it is an IDEA. If you are planning to start next year, it is a PRE START-UP.

If you have been making consistent sales for less than a year, your business is a START-UP. Please answer the questions below.

* Do you have any EMPLOYEES, BUSINESS PARTNERS, or VOLUNTEERS?

If yes, please fill in chart below:

Type of Workers	Number of Workers	Hours / Week (per worker)	Months / Year (per worker)	Wage / Hour
Business Partner(s)
Employee(s)
Temporary Employee(s)
Contract Worker(s)
Volunteer(s)

If you have been in business for six months or more, please answer the following questions.
If you have been in business for less than six months, please type any comments at the bottom of this form and initial your approval, and you are done! Thanks!

* Is your business reaching or exceeding BREAK-EVEN?

If yes, when did you begin to break-even? (required if you answered yes)

mm	dd	yyyy

* Have you reached your MINIMUM INCOME GOAL? (While you may be hoping or planning to expand your business, we mean the minimum income in order for you to continue working in your business over other options you have, such as working for someone else!)

If yes, when was your minimum income goal first achieved? (required if you answered yes)

mm	dd	yyyy

* Have you set prices for your product or service?

Have you or are you in the process of FORMALIZING YOUR BUSINESS by:

If you have been in business for over one year and are earning your minimum income goal your business is ESTABLISHED.

If you have been in business for over a year but are not yet achieving your minimum income goal your business is EXISTING.

If your business is breaking even and may be in the process of formalization, it has STABILIZED.

How would you describe your business operations systems?

* Have your sales, production, or number of clients significantly increased in the last 6-12 months?

If yes, when did your sales, production, or client base expand? (required if you answered yes)

mm	dd	yyyy

Has your business EXPANDED by: You may select more than one...
(hold down the CTRL key while clicking to select more than one).
Date of Change:

If other, please describe in a few words:

Have your SALES INCREASED SIGNIFICANTLY and stayed at this higher rate compared to the last 6-12 months?
Since what date:

If you selected any of the above, your business has EXPANDED!
Please answer the following two questions:

Has your business gone back to reaching or exceeding break-even?
Since what date:
Have operations stabilized to accommodate these changes?
Since what date:

If the answer to these questions is YES, your business has STABILIZED after the expansion.

Has your business CONTRACTED by: You may select more than one...
(hold down the CTRL key while clicking to select more than one).
Date of Change:

If other, please describe in a few words:

Have your SALES DECREASED SIGNIFICANTLY and stayed at this lower rate compared to the last 6-12 months?
Since what date:

If you selected any of the above and your business has CONTRACTED, please answer the following two questions:

Has your business gone back to reaching or exceeding break-even
Since what date:

Have operations stabilized to accommodate these changes?
Since what date:

OPTIONAL: If the answer to these questions is YES, your business has STABILIZED after the contraction.
(Your answer will not affect your eligibility for the client directory, so please reply honestly. It will help us assess our program outcomes.)

What are your AVERAGE MONTHLY SALES AND EXPENSES in the last year or since your business started?
Average sales / month:
Average expenses / month:
Notes (seasonal fluctuations, unique circumstances, etc):

Thank you for helping us to better serve all our graduates! Please share any additional comments you may have.

I,
(your Name)
,
grant permission for Women’s Initiative to promote my business and publish my business contact information in all the ways indicated at the beginning of this survey.

If you have questions about filling out this form, please contact the Evaluation Department at (510) 287-3103.