Small Business Grant-Writing Questionnaire Please enable JavaScript in your browser to complete this form.Hello! Thank you for your interest in our services! We’d love to help you position your small business for grant funding, but first we’d like to learn more. After completing this form, you’ll be directed to a link to schedule your discovery call. Heads-up! The first 8 questions are required! Thank you! Section 1: Business Overview. This section captures the basics that funders use to verify eligibility and confirm your business is properly established. We’ll use this information to match your business to grant requirements.1. Your Name: *FirstLast2. Your Role in the Business: * OwnerCo-OwnerPartnerGeneral ManagerOther3. Your Email: *4. Your Phone Number: *About Your Business5. Business Name: *Please enter the full legal name DBA/Trade Name: If different from above: *Write N/A if you do not have a DBA6. Business Physical Address: *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code7. What does your business do? We sell productsWe offer servicesWe offer products and servicesWe have not officially launched yet.7a. Describe the products offered by your business:7b. Describe your business services:7c. Please describe the products and services offered by your business:7d. Describe the goals for your business and share your anticipated launch date:8. Are you ready to engage in Grant-Writing services? * Yes – ImmediatelyYes – Within 30 daysI am not sure. I’d like to learn more first.No – I am just curiousOptional The remainder of the questions on this form are “optional” and intended for business owners that are serious about grant-writing. If you would simply like to meet with Cheryl Smith to learn more about our services, it’s okay to stop here, submit the form, and schedule your appointment! Thank you for your interest! Section 2: Let’s wrap up your business overview with a few more questions that will help us understand your business profile, operations, and target market.9. Month/Year Established?10. Legal Structure? Sole ProprietorshipPartnershipLimited Liability Company (LLC)Corporation (C-Corp)S- Corporation (S-Corp)None of the aboveOther / Something Else11. EIN:12. Website / URL:13. Annual gross revenue last calendar year? $0- $50,000$50,001 – $100,000$100,000 – $150,000$150,001 – $250,000$250,001 – $500,000$500,001 – $1 Million$1 Million – $2 Million$2 Million – $5 Million$5 Million+14. Annual gross revenue (actual or anticipated) this calendar year? $0- $50,000$50,001 – $100,000$100,000 – $150,000$150,001 – $250,000$250,001 – $500,000$500,001 – $1 Million$1 Million – $2 Million$2 Million – $5 Million$5 Million+15. Employees: How many employees do you currently have? Just me!1-55-1011+16. Business Documentation: Do you have the following prepared? (Check if yes): Business PlanFinancial StatementsDUNS NumberSAM.gov UEI Number17. Target Market: Who are your primary customers? (Demographics, location, etc.)18. Competition: Who are your main competitors?Section 3: Funding Request & GoalsThis section focuses on what you want to fund how much is needed, and what the funding will be used for. Understanding this information helps us to develop persuasive applications.19. Have you applied for grants in the past? YesNo20. Do you have a specific grant that you are interested in? If yes, please share details.21. How much are you seeking in grant funding?IMPORTANT: This questionnaire is being used to gather information to prepare you to submit applications for entry level grants, pitch contests, small business challenges, incubators, and accelerators. This service and questionnaire is not intended for use in government grant applications. 22. If awarded, what will you spend the money on? Select all that apply.Working capital and operationsHiring employees / contractorsMarketing and advertisingTechnology and innovationInventory and suppliesProduct developmentEquipmentResearchExpansion and new locationsSomething else22a. Please explain your above selection(s)23. When is this funding needed? Within 90 daysWithin 6 monthsWithin 1 yearOther / Something Else24. Which grant priority does your project support? Select all that apply.Job CreationWorkforce training or skills developmentSupport for small or minority-owned businessesTechnology and InnovationDevelopment or Integration of Artificial IntelligenceProduct or service innovationExpansion into new markets or locationsSupport for underserved or rural communitiesEnvironmental sustainability or energy efficiencySupply chain strengthening or local sourcingHealthcare access or public health improvementEducation or training servicesManufacturing or production capacity growthAgriculture or food system supportDisaster recovery or business resilienceExport development or global market readinessResearch and developmentInfrastructure or facility improvementsPatent Pending ProjectOther / Something else25. Have you participated in any of the following? Select all that apply.Pitch CompetitionChallenge GrantsIncubator ProgramBusiness ExceleratorMentoring through SCORE.orgMentoring from a Small Business Development CenterVeteran Entrepreneur Training ProgramWomen’s Entrepreneur Training ProgramBusiness Certification ProgramOther / Something Else26. If you answered "Other / Something Else" to any question, please explain:27. Please share any questions or comments that you have for Cheryl Smith:28. Please confirm your authority to engage in grant-writing services by typing in your full name below:29. Today's Date Submit
