Tell Us Your Story! In partnership with the Main Street Alliance, and The Black upStart, Color of Change and United State of Women Business/Organization Name * Name * First Name Last Name Title * Email * How were you/your business impacted by COVID? Tell us your story! * Best Contact Phone * (###) ### #### Preferred Method/Time to Follow up State Where Business is Located * City Where Business is Located * Number of Employees (pre-COVID) Business Website, if any Demographic Section - Feel free to complete if comfortable Gender Male Female Non-Binary Other Ethnicity - check any/all you indentify with: American Indian or Alaska Native Black or African American Asian Hispanic, Latinx, or Spanish Origin Native Hawaiian or Pacific Islander White Other Do Not Wish to Disclose Age Range 18 - 30 30 - 40 40 - 50 50 - 60 60 + Thank you!